Responsiveness of AF6, a new, short, validated, atrial fibrillation-specific questionnaire--symptomatic benefit of direct current cardioversion.
OBJECTIVE
To measure the effects on symptoms of electrical cardioversion (DC) in patients with atrial fibrillation (AF) by means of a new, short, validated, AF-specific questionnaire, the AF6.


METHODS
One hundred eleven patients (67 ± 12 years, 89 men) were screened before and 12 ± 3 days after DC using AF6, covering 'breathing difficulties at rest', 'breathing difficulties on exertion', 'limitations in day-to-day life due to atrial fibrillation', 'feeling of discomfort due to atrial fibrillation', 'tiredness due to atrial fibrillation', and 'worry/anxiety due to atrial fibrillation'. A single global score was calculated. The Toronto AF Symptoms and Severity Check List (AFSS) and the generic SF-36 were also administered. Patients in sinus rhythm at 12 ± 3 days (n = 56) were defined as responders and patients in AF (n = 55) as non-responders.


RESULTS
The mean single global score decreased in all patients (18 ± 12.4 to 13 ± 11.6, p < 0.0001) and in responders (22 ± 14 vs. 12 ± 12, p < 0.01) but not in non-responders (14 ± 9 vs. 14 ± 11, N.S). The AFSS frequency scores decreased from 14.5 ± 7.7 to 9.5 ± 7.8 in responders, p = 0.001, but not in non-responders. There was a strong correlation between changes in the AF6 and the SF-36 regarding four of the six items. Effect sizes of AF6 ranged from 0 to 0.52 in all patients, in responders from 0.10 to 0.85 and in non-responders from -0.23 to 0.34, the highest figures consistently referring to 'tiredness due to atrial fibrillation'.


CONCLUSIONS
The symptom scores measured by AF6 decreased significantly, especially in responders. AF6 demonstrated adequate responsiveness to change, and effect sizes were mostly moderate, in responders moderate to high.
Härdén
Marie
M
Division of Cardiology, Sahlgrenska University Hospital, 413 45 Göteborg, Sweden.
Nyström
Britta
B
Bengtson
Ann
A
Medin
Jennie
J
Frison
Lars
L
Edvardsson
Nils
N
D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy*; D004554:Electric Countershock; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
Circulation. 2000 Jun 6;101(22):2607-11
10840012
Pacing Clin Electrophysiol. 2007 Apr;30(4):554-67
17437583
Circulation. 2004 Mar 30;109(12):1509-13
15007003
Soc Sci Med. 1995 Nov;41(10):1349-58
8560302
Pacing Clin Electrophysiol. 2005 Aug;28(8):801-7
16105008
Med Care. 1989 Mar;27(3 Suppl):S178-89
2646488
Eur Heart J. 2003 Aug;24(15):1387-400
12909067
Chest. 2007 Oct;132(4):1259-64
17646231
Europace. 2003 Oct;5(4):351-5
14753629
J Am Coll Cardiol. 2006 Aug 15;48(4):721-30
16904540
Am Heart J. 2005 Jan;149(1):112-20
15660042
Int J Cardiol. 2005 Oct 20;105(1):26-30
16207541
Int J Cardiol. 2001 Nov;81(1):29-35
11690662
Drugs. 2005;65(12):1651-67
16060699
Am J Med. 2006 May;119(5):448.e1-19
16651058
Pharmacoeconomics. 2005;23(7):687-708
15987226
Am Heart J. 2002 Jun;143(6):984-90
12075253
Am Heart J. 2004 Aug;148(2):318-25
15309003
Heart. 2001 Feb;85(2):216-7
11156677
Eur J Cardiothorac Surg. 2009 Sep;36(3):558-62
19520588
N Engl J Med. 2002 Dec 5;347(23):1834-40
12466507
N Engl J Med. 2002 Dec 5;347(23):1825-33
12466506
J Psychosom Res. 2006 Dec;61(6):769-74
17141664
Health Qual Life Outcomes. 2009 Jul 15;7:65
19604399