Table 1.
Prevalence of Symptoms
| Study | Sample | Prevalence of Symptoms | Symptom Type | Instrument | Important to Note |
|---|---|---|---|---|---|
| Diker, 2015, Turkey(22) | N=510, 56% permanent, 21% persistent, 13% paroxysmal | 56% had symptoms in past 7 days, 78.8% had symptoms in past year | 34.5% dyspnea, 34.4% palpitations, and 32.5% fatigue | EHRA | EKG findings indicated that 88.4% of patients were in AF at time data was collected |
| Dorian, 2000, US, Canada, Germany and England(29) | N=152, 60% paroxysmal, 40% persistent | 90% reported symptoms during AF | 68% palpitations, 62% fatigue, 60% shortness of breath | AFSS | Permanent AF patients were excluded |
| Golwala, 2016, US(7) | N=9542, 51% paroxysmal, 45% persistent/permanent, 4% Undetermined | 62% reported symptoms | 32% palpitations, 28% dyspnea, 26% fatigue | EHRA, AFEQT | The EHRA classification, done by physicians, and AFEQT, done by patients, were highly correlated, though findings suggest physicians may underestimate mild AF symptoms |
| Ha, 2014, 21 countries(8) | N=2439, 52% paroxysmal, 43% persistent, 5% Undetermined | Baseline score of 8.7 SD 7 | Not described | AFSS | Cohort consists of recent-onset AF patients |
| Patel, 2014, US(31) | N=286, 40% persistent, 60% paroxysmal | 25% reported severe AF symptoms | Not described | AFSS | Stable outpatient sample |
| Kupper, 2013, Netherlands(32) | N=52, persistent | 9 symptoms on average with an average frequency of 2.5 during AF | 92% tiredness 76% dyspnea, 70% heart racing | ATSSS | Persistent AF sample that was a substudy, pre-ablation data examined |
| Murin, 2014, 26 countries(33) | N=4869,
permanent N=6622, Nonpermanent |
Permanent: 25% reported severe
symptoms Nonpermanent: 19.7% EHRA Class III reported severe symptoms |
Not reported | EHRA | 50% of permanent AF patients did not have controlled AF in this sample |
| Nieuwlatt, 2005, 35 countries(23) | N=5333, 28% paroxysmal, 21% persistent, 29% permanent | 69% currently symptomatic | 75% palpitations and/or syncope | Not described | Majority of the patients were recruited from university and specialized centers |
| Patten, 2006, Germany(34) | N=1033, Symptomatic paroxysmal | Palpitations, tachycardia, and dyspnea most prevalent in EKG-confirmed AF episodes, palpitations, angina, and vertigo most common in perceived AF episodes in SR | Self-monitoring event recorder system | Study reviewed of patient-reported symptomatic AF events against the EKG-report | |
| Rienestra, 2005(26) | N=522, Recurrent persistent | 70% reported symptoms | 39% fatigue, 35% dyspnea, 27% palpitations | Not described | No data of how symptom information was collected, and how patients were questioned about symptoms |
| Sears, 2005, US(27) | N=96 | Average of 8.89 AF symptoms across participants | Tiredness and difficulty sleeping two most frequently experienced | ATSSS | Sample consisted of symptomatic, drug refractory AF patients |
| Singh, 2006, US(25) | N=496, Persistent | 63% perceived symptomatic AF | AF symptom burden score 13.4, SCL frequency 18.15, SCL severity of 14.6 | SCL, AFSS | Symptom prevalence reported as baseline data from a longitudinal study on AF control |
| Siontis, 2016, US(35) | N=476 | 66% reported symptoms | 40% palpitations, 26% symptoms other than palpitations | No standardized measurement of symptoms, data was based on information from chart review | |
| Steg, 2012, 26 countries located in Europe, the Middle East, Africa, Asia & America (10) | N=9665, | 61% reported symptoms in past 7 days, 22% reported severe symptoms | 39.4% dyspnea, 35.5% fatigue, 33.8% palpitations | EHRA | Study has unprecedented geographical relevance, includes developing low- and middle-income countries |
| Vermond, 2014, Netherlands(11) | N=558, Permanent | 35% reported a high symptom severity, 34% moderate symptom severity | 76% dyspnea, 75% fatigue, 53% palpitations | AFSS | Self-reported AFSS scores were more sensitive than the history taking by treating physician, 70% of patients who reported mild symptoms were classified as asymptomatic by physician |
Abbreviations: AF, atrial fibrillation; EKG, electrocardiogram; EHRA, European Heart Rhythm Association score of AF-related symptoms; AFSS, Atrial Fibrillation Symptom Severity Scale; SCL, Symptom Checklist; SR, sinus rhythm; ATSSS, Atrial Tachyarrhythmia Symptom Severity Scale, AFEQT Atrial Fibrillation Effect on QualiTy of Life