ASSESSMENT OF PHYSICAL AND MENTAL HEALTH IN ARRHYTHMOLOGICAL DAY HOSPITAL FOR PERSISTENT ATRIAL FIBRILLATION

Objectives: of the study was the evaluation of the sub­ jective symptoms burden and quality of life in outpatients with atrial fibrillation as component of the management pro­ cess and its relation and role in early relapse episodes after electrical cardioversion. Methods used: A total of 84 outpatients with documented atrial fibrillation (AF) were recruited in our Arrhythmolog­ ical Day Hospital from January 2007 to December 2010. A staff of nurses, psychologists, and cardiologists worked together to select patients for electrical cardioversion and follow the trend of the examined population . At baseline were collected: clinica! visit , European Heart Rhythm Association (EHRA) class, AF pattern (first de­ tected episode, paroxysmal, persistent , permanent), duration of AF, current treatrnents , CHADS2 score, 24-hour Holter were recorded. Each patient received every 3 months for one year, a questionnaire (AF Quality of Life questionnaire-QoL-) with three domains: psychological, physical and sexual activity. toms based program. In all pts rate control and upstream therapy were applied , plus anticoagulation with warfarin if CHADS2 score was up pts with paroxysmal and persistent AF were planned for electrical cardioversion (ECV). Mean age was 68± 9 years, male gender was 58%. Paroxysmal form was represented in 24%, persistent in 38%, first diagnosed episode in 27%, permanent in 10%. CHADS2 score 1 was present in 32%, CHADS2 was 2 in 21%, > 2 in 45%. Risk factors and underlying pathologies were: hypertension in 66%, heart failure with ejection fraction 40% in 27%, coronary beart disease in 20%, valvulopathy in 30%, diabetes in 21%, hypercholesterolemia in 32%. Results: QoL was lower at study entry for outpatients with parosysmal and persistent AF especially among female sex, in the subscale of physical functioning, mental health, and social functioning. During the 12-month follow up the QoL scores increased and EHRA class ameliorated in pts with paroxysmal and persistent AF with an improvement also in EHRA functional class irrespective of strategy adopted (rhytbm or rate control) . No signifìcant changes in QoL scores in pts with per­ manent AF were demonstrated at the end of the study. Sinus rhytbm at the end of the study was correlated to most relevant QoL scores improvement in pts during follow up. Conclusions: Clinical management of AF must handle with a wide range of symptoms that affect quality of life. Assessment of physical and mental health with specifìc instruments may be a worthwhile effort to select and choose appropriate interventional options.