title: Depressed mood amplifies heart-related symptoms in persistent and paroxysmal atrial fibrillation patients: a longitudinal analysis--data from the German Competence Network on Atrial Fibrillation.
abstract: OBJECTIVE
  There is limited evidence of an association between the burden of atrial fibrillation (AF)-related symptoms and depressed mood (DM). We used follow-up data from two randomized trials to relate AF symptoms, perceived AF burden, and DM.
  
  
  RESULTS
  Baseline data on 319 persistent AF patients from the Flec-SL trial and 244 paroxysmal AF patients from the ANTIPAF trial were available. Data on 400 patients were available at 6-month follow-up. Depressed mood was measured using the major depression inventory, AF symptoms using the AF Symptom Checklist. Generalized estimating equation models were used to assess the association between symptom burden and DM. At baseline, 194 patients (35.2%) reported DM, 294 (52.2%) reported severe AF symptom burden. Burden from all symptoms except fainting was significantly elevated in patients with DM. An improvement in DM from baseline to follow-up was associated with reduced symptom burden [odds ratio (OR) = 2.06; 95% confidence interval (CI): 1.22-3.51]. Patients with DM had three-fold increased odds of severe symptom burden after adjustment for perceived AF-frequency and -duration, sex, and chronic obstructive pulmonary disorder (COPD) (OR = 3.19; 95% CI: 2.65-8.45). Women reported significantly more severe symptom burden than men (OR = 1.44; 95% CI: 1.36-1.95). Uneasiness, nausea, and shortness of breath were most strongly associated with DM. The effect of DM on nausea was more pronounced for men (P(interaction) = 0.041). Perceived AF-frequency and -duration were not associated with DM (P = 0.717 and 0.236, respectively).
  
  
  CONCLUSIONS
  Depressed mood is associated with AF symptom burden over 6 months after adjustment for perceived frequency and duration of AF episodes, COPD, and sex.
authors.affiliation: Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstr. 1, Neuherberg 85764, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: von Eisenhart Rothe
authors.affiliation: Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstr. 1, Neuherberg 85764, Germany.
authors.forename: Frederick
authors.initials: F
authors.lastname: Hutt
authors.affiliation: Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstr. 1, Neuherberg 85764, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Baumert
authors.affiliation: Department of Cardiovascular Medicine, University Hospital Münster, Germany.
authors.forename: Günther
authors.initials: G
authors.lastname: Breithardt
authors.affiliation: Department of Cardiology and Intensive Care, St Vincenz Hospital Paderborn, Germany Working Group Molecular Electrophysiology, University Hospital Magdeburg, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Goette
authors.affiliation: University of Birmingham Center for Cardiovascular Sciences, University of Birmingham, Birmingham, UK Department of Cardiovascular Medicine, University Hospital Münster, Germany.
authors.forename: Paulus
authors.initials: P
authors.lastname: Kirchhof
authors.affiliation: Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstr. 1, Neuherberg 85764, Germany Department of Psychosomatic Medicine and Psychotherapy, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany ladwig@helmholtz-muenchen.de.
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Ladwig
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000523:psychology*; D003863:Depression / Q000175:diagnosis*; D018450:Disease Progression; D005260:Female; D005858:Germany; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011569:Psychiatric Status Rating Scales; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D012720:Severity of Illness Index
keywords: ANTIPAF; Atrial fibrillation; Depression; Flec-SL; Mental health; Symptoms