Abstract
BACKGROUND: Atrial fibrillation (AF) often manifests with distressing symptoms, impaired quality of life (QoL), and increased health care consumption. Rhythm and rate control treatments may have limited impact on QoL. Symptom preoccupation, that is, fear of cardiac-related symptoms and avoidance behavior, may contribute to disability in AF but remains understudied. OBJECTIVES: The objective of the study was to investigate the prevalence of symptom preoccupation in AF and its association with impaired QoL, general disability, symptom severity, and health care visits, in a general AF sample. METHODS: This cross-sectional study recruited 409 Swedish AF patients who completed an online survey on demographics, medical history, and measures of AF-specific QoL (AF effects on QoL; AFEQT), general disability, AF health care use, and symptom preoccupation (Cardiac Anxiety Questionnaire) and other psychological variables, including depression and general anxiety. RESULTS: Symptom preoccupation was present in 37% of respondents (59% females and 23% males) and showed the strongest association with impaired QoL (regression coefficient [β]: -0.51; 95% CI: -0.61 to -0.41; P < 0.001), health care use (incidence rate ratio: 1.67; 95% CI: 1.28-2.19; P < 0.001), and symptom severity (β: 0.39; 95% CI: 0.27-0.50; P < 0.001). Depression was most strongly associated with general disability (β: 0.45; 95% CI: 0.32-0.58; P < 0.001), whereas symptom preoccupation also showed a significant but weaker association (β: 0.31; 95% CI: 0.19-0.43; P < 0.001) with general disability. CONCLUSIONS: Symptom preoccupation is common in AF patients. Behavioral interventions that specifically target symptom preoccupation could potentially increase QoL, reduce health care use, and improve symptom experience in AF.