Discrepancy in recognition of symptom burden among patients with atrial fibrillation - 09/06/20

Doi : 10.1016/j.ahj.2020.03.024

Yoshinori Katsumata, MD, PhD ^a,^b,^{^⁎} , Takehiro Kimura, MD, PhD ^a, Shun Kohsaka, MD, PhD ^a, Nobuhiro Ikemura, MD, PhD ^a, Ikuko Ueda, PhD ^a, Taishi Fujisawa, MD, PhD ^a, Kazuaki Nakajima, MD, PhD ^a, Takahiko Nishiyama, MD, PhD ^a, Yoshiyasu Aizawa, MD, PhD ^c, Takahiro Oki, MD, PhD ^d, Masahiro Suzuki, MD, PhD ^e, Paul A Heidenreich, MD, PhD ^f, Keiichi Fukuda, MD, PhD ^a, Seiji Takatsuki, MD, PhD ^a
^a Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
^b Institute for Integrated Sports Medicine, Keio University School of Medicine, Tokyo, Japan
^c Department of Cardiology, International University of Health and Welfare Narita Hospital, Chiba, Japan
^d Department of Cardiology, Tokyo Dental College Ichikawa General Hospital, Tiba, Japan
^e Department of Cardiology, National Hospital Organization Saitama National Hospital, Japan
^f Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA

^⁎Reprint requests: Yoshinori Katsumata, MD, PhD, 35 Shinanomachi Shinjuku-ku Tokyo, JAPAN 160–8582, Department of Cardiology, Keio University School of Medicine.Department of CardiologyKeio University School of Medicine35 Shinanomachi Shinjuku-ku Tokyo160–8582JAPAN

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Background

Our aim was to investigate the variability in physician recognition of atrial fibrillation (AF)-related symptoms, which greatly contributes to the management of AF patients.

Methods and Results

A total of 1493 newly-referredAF patients (67 ± 11 y/o, 1057 men) consecutively registered in an outpatient-based Japanese multicenter database (KiCS-AF) from September 2012 to December 2016 were analyzed. Self-reportedAF symptom burden was assessed via symptom and daily activities domains within the Atrial Fibrillation Effect on QualiTy-of-life (AFEQT) questionnaire. Physician symptom under-recognition (UR) was defined as no subjective complaints recorded in the medical records despite AFEQT score of <80; and physician's apparent over-recognition (OvR) was defined as documentation of subjective complaints despite total AFEQT score of ≥80. There was poor agreement between patient-reported and physicians-estimated symptom burden (kappa 0.28, 95% CI 0.23 to 0.33). In the logistic regression analysis, age> 75 (odds ratio [OR], 1.72; 95% confidence interval [CI], 1.13–2.62), male sex (OR, 1.82; 95% CI, 1.22–2.74), and persistent/permanent AF (OR 2.54/3.36; CI, 1.63–3.99/1.91–5.89, respectively) were predictors of UR. Conversely, heart failure (OR, 2.46; 95% CI, 1.44–4.25) and treatment in an ablation facility (OR, 1.43; 95% CI, 1.02–2.02) were associated with greater odds of OvR in addition to age, sex, and type of AF.

Conclusions

Discordance in recognition of AF symptom burden by physicians was frequent in AF patients seen in outpatient management and involved both patient- and physician-related factors.

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Plan

Methods

Patient population

Information disclosure

Follow-up examinations

Assessment of symptom burden and definition of under- or over-recognition

Study design

Statistical analysis

Results

Baseline characteristics

Discordance in recognition of symptom-burden

Effect of clinical characteristics on recognition of AF-related symptoms

Quality of life

Discussion

Conclusion

	Sources of funding: This study was funded by a Grant-in-aid for scientific research from the Japan Society for the Promotion of Science (‘Kakenhi’, Grant numbers 20H03915, 16KK0186, 16H05215, 25,460,630, and 25,460,777) and by an unrestricted research grant from Bayer Yakuhin Ltd.
	Disclosure: S.K. reports investigator‐initiated grant from Bayer and Daiichi Sankyo. The remaining authors have no disclosures to report.