Symptom severity and quality of life in patients with atrial fibrillation: Psychological function outweighs clinical predictors

Tomos E. Walters, Kate Wick, Gabriel Tan, Megan Mearns, Stephen A. Joseph, Joseph B. Morton, Prash Sanders, Christina Bryant, Peter M. Kistler, Jonathan M. Kalman

Research output: Contribution to journalArticle

5 Citations (Scopus)


Background: The key drivers of symptom severity and health-related quality of life (hr-QOL) in patients with atrial fibrillation (AF) remain unclear. We aimed to determine the relative contribution to symptom severity and hr-QOL of clinical factors including left ventricular (LV) diastolic function and ventricular rate control during AF and of psychological functioning. Methods: Seventy-eight consecutive patients with symptomatic AF and preserved LV systolic function underwent detailed evaluation of i) AF symptom severity and hr-QOL; ii) clinical factors including left ventricular (LV) diastolic function, AF burden, and ventricular rate during AF and iii) state and trait aspects of psychological functioning. Results: Moderate-to-severe AF-related symptoms were reported by 64% of the study population whilst 36% reported no more than mild symptoms. Worse symptom severity was associated with a higher score on the Perceived Stress Scale (16.7 ± 4.4 vs. 5.4 ± 4.4, p < 0.0001) and higher prevalence of the Type D Personality (20/50 vs. 4/28, p = 0.012). In multivariable models, only a predisposition to subjectively appraise life situations as stressful (higher PSS score) and a personality with a higher degree of negative affectivity and social inhibition (higher TDPS score) were independent predictors of higher AF symptom severity and poorer hr-QOL. No clinical factors including AF burden, ventricular rates during AF or LV diastolic function were significant predictors of AF-specific symptoms or hr-QOL. Conclusion: In a tertiary AF population with preserved LV systolic function, only psychological functioning consistently predicts both AF-related symptoms and hr-QOL. LV diastolic function, AF burden, and ventricular rate during AF are not independent predictors.

Original languageEnglish
Pages (from-to)84-89
Number of pages6
JournalInternational Journal of Cardiology
Publication statusPublished - 15 Mar 2019


  • Atrial fibrillation
  • Personality
  • Quality of life
  • Symptoms
  • Type D personality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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