Symptom Clusters in Adults With Chronic Atrial Fibrillation.
Megan Streur, Sarah J Ratcliffe, Jocasta Ball and 2 others
PMID 27203271WHAT IT FOUND
Adults with chronic atrial fibrillation reported symptoms in three distinct clusters.
The 'heart' cluster of palpitations and chest pain was most common, affecting 26% of participants. Membership in this cluster was associated with being younger, female, and using anti-arrhythmic medications.
Key findings
01Symptoms clustered into three groups: a rare 'vagal' cluster (nausea, diaphoresis), a 'tired' cluster (fatigue, weakness, dizziness, breathlessness), and a 'heart' cluster (chest pain, palpitations).
02The heart cluster was the most common, present in 26% of participants, while the tired cluster was present in 14% and the vagal cluster in only 3 individuals.
03Participants with the heart cluster were significantly younger, more likely to be female, and more likely to be taking anti-arrhythmic medications than those without the cluster.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The symptom survey tool used was not validated psychometrically. Approximately two-thirds of the cohort had high levels of cognitive impairment, which may have affected the accuracy of self-reported symptoms. Symptoms were self-reported and not correlated with objective heart rhythm monitoring. The study excluded patients with heart failure, limiting generalizability to that common comorbidity. The sample was predominantly European/Caucasian (96%), which may not reflect other populations.
The easy way to misread this
Do not interpret the associations as causal. The study is a cross-sectional analysis, so it cannot determine if anti-arrhythmic medications cause the heart cluster symptoms or if patients with these symptoms are more likely to be prescribed these medications. Additionally, the 'tired' symptoms were not linked to rate-control medications in this analysis, despite known side effects, so nurses should not assume medication side effects are the sole driver of fatigue in this group.