Atrial Fibrillation Symptoms and Sex, Race, and Psychological Distress: A Literature Review.
Kelly T Gleason, Saman Nazarian, Cheryl R Dennison Himmelfarb
PMID 28628500WHAT IT FOUND
Most people with AF reported palpitations, fatigue, or shortness of breath.
Symptoms were more common in women and linked to anxiety or depression and fast heart rate, but what patients reported did not consistently match what monitors showed.
Key findings
01In three studies using one common symptom scale, 56% to 62% of AF patients reported one or more symptoms in the past seven days, and shortness of breath, fatigue, and palpitations were the most commonly reported symptoms.
02Most studies found symptomatic AF more common in women; five studies supported links with anxiety or depression, and seven supported a link to heart rate above 100 beats per minute.
03Symptom tools varied widely, and most were developed in predominantly Caucasian male samples; only three studies examined race, and those found nonwhite patients were more likely to report symptoms than Caucasian patients.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The review is explicitly not systematic and not all-inclusive, so relevant studies may have been missed. Only English language, peer-reviewed studies with 100% of participants diagnosed with AF were included. Symptom instruments varied in symptoms, wording, and time frames, so prevalence estimates are not directly comparable. Most included studies were observational, and few were designed specifically to study AF symptoms. Samples were largely male and largely Caucasian, so findings may not generalize to women and non-white patients. The review reports associations, not causes, and does not test whether psychological distress, sex, or race produce symptoms.
Declared interests
The article declares that Dr. Nazarian is a scientific advisor to Biosense Webster Inc. and CardioSolv Inc. and is principal investigator for research funding to Johns Hopkins from Biosense Webster. All other authors reported no conflicts. The metadata lists NIH extramural research support.
The easy way to misread this
Do not conclude that a patient's symptom report tells you whether AF is happening. Several studies found little association between symptoms and monitor-detected AF, and in four studies symptoms detected 19% or fewer of pacemaker-reported AF episodes.