title: The influence of depression and anxiety symptoms on health-related quality of life in patients with atrial fibrillation and atrial flutter.
abstract: BACKGROUND
  The health-related quality of life (HRQoL) of patients with atrial fibrillation (AF) and atrial flutter (AFL) is an important issue in cardiovascular health management. Determinants of poor HRQoL of AF/AFL patients require further elucidation.
  
  
  OBJECTIVE
  The purpose of this study was to evaluate the influencing factors related to the HRQoL of AF/AFL patients.
  
  
  METHODS
  In 150 consecutively recruited patients in a multicenter, cross-sectional study from April 2010 to February 2011, depression and anxiety were measured with the Beck Depression Inventory II and the State Trait Anxiety Inventory, respectively, whereas HRQoL was assessed with the generic Medical Outcomes Survey 36-Item Short-Form Survey version 2 and the Symptom Checklist. Linear regression modeling was performed to determine predictors of HRQoL among variables, including the patients' age, gender, race, marital status, type of AF/AFL, frequency of AF/AFL symptoms, time since diagnosis, and anxiety and depression symptoms.
  
  
  RESULTS
  Female patients with AF/AFL reported poorer physical HRQoL than male patients did (P < .001, R² = 0.391). Symptoms of depression and anxiety were found to be associated with poorer HRQoL (P < .001, R² = 0.482). Anxiety was the strongest predictor of the mental component of the Medical Outcomes Survey 36-Item Short-Form Survey version 2 and the Symptom Checklist. Younger patients had worse AF/AFL-related symptoms and severity than older patients did (P < .001, R² = 0.302). Increased frequency of symptomatic episodes was associated with worse AF/AFL-related symptoms and severity.
  
  
  CONCLUSIONS
  In conclusion, depression and anxiety symptoms and female gender emerged as clear indicators of poor HRQoL in AF/AFL patients. These risk factors should be used to identify patients who may require additional evaluation and treatment efforts to manage their cardiac conditions or HRQoL. Interventions to improve HRQoL in these individuals require further investigation.
authors.affiliation: Bimbola Fola Akintade, PhD, ACNP-BC, MBA, MHA Assistant Professor and Specialty Director, Adult Gerontological Acute Care Nurse Practitioner/Clinical Nurse Specialist Program, School of Nursing, University of Maryland, Baltimore. Deborah Chapa, PhD, ACNP-BC Assistant Professor, School of Nursing, George Washington University, Washington, DC. Erika Friedmann, PhD Professor, School of Nursing, University of Maryland, Baltimore. Sue Ann Thomas, PhD, RN, FAAN Professor and Assistant Dean, PhD Program, School of Nursing, University of Maryland, Baltimore.
authors.forename: Bimbola Fola
authors.initials: BF
authors.lastname: Akintade
authors.forename: Deborah
authors.initials: D
authors.lastname: Chapa
authors.forename: Erika
authors.initials: E
authors.lastname: Friedmann
authors.forename: Sue Ann
authors.initials: SA
authors.lastname: Thomas
mesh_terms: D000367:Age Factors; D000368:Aged; D001007:Anxiety / Q000523:psychology*; D001281:Atrial Fibrillation / Q000523:psychology*; D001282:Atrial Flutter / Q000523:psychology*; D003430:Cross-Sectional Studies; D003863:Depression / Q000523:psychology*; D004219:District of Columbia / Q000453:epidemiology; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008396:Maryland / Q000453:epidemiology; D011788:Quality of Life; D012737:Sex Factors; D011795:Surveys and Questionnaires