The Influence of Depression and Anxiety Symptoms on Health-Related Quality of Life in Patients With Atrial Fibrillation and Atrial Flutter

Background: The health-related quality of life (HRQoL) of patients with atrial fibrillation (AF) and atrial flutter (AFL) is an important issue in cardiovascular health management. Determinants of poor HRQoL of AF/AFL patients require further elucidation. Objectives: The purpose of this study was to evaluate the influencing factors related to the HRQoL of AF/AFL patients. Methods: In 150 consecutively recruited patients in a multicenter, cross-sectional study from April 2010 to February 2011, depression and anxiety were measured with the Beck Depression Inventory II and the State Trait Anxiety Inventory, respectively, whereas HRQoL was assessed with the generic Medical Outcomes Survey 36-Item Short-Form Survey version 2 and the Symptom Checklist. Linear regression modeling was performed to determine predictors of HRQoL among variables, including the patients' age, gender, race, marital status, type of AF/AFL, frequency of AF/AFL symptoms, time since diagnosis, and anxiety and depression symptoms. Results: Female patients with AF/AFL reported poorer physical HRQoL than male patients did (P < .001, R-2 = 0.391). Symptoms of depression and anxiety were found to be associated with poorer HRQoL (P < .001, R-2 = 0.482). Anxiety was the strongest predictor of the mental component of the Medical Outcomes Survey 36-Item Short-Form Survey version 2 and the Symptom Checklist. Younger patients had worse AF/AFL-related symptoms and severity than older patients did (P < .001, R-2 = 0.302). Increased frequency of symptomatic episodes was associated with worse AF/AFL-related symptoms and severity. Conclusion: In conclusion, depression and anxiety symptoms and female gender emerged as clear indicators of poor HRQoL in AF/AFL patients. These risk factors should be used to identify patients who may require additional evaluation and treatment efforts to manage their cardiac conditions or HRQoL. Interventions to improve HRQoL in these individuals require further investigation.