Between February 2004 and September 2008, 334 patients (41% female and 59% male) with paroxysmal AF, without significant concomitant heart disease, and their physicians from 43 participating centres were asked to rate the patients' heath related quality of life (HRQoL). Patients filled in the SF-12 self rating scale in the clinic or home; while physicians complete the SF8 scale after the patient had left the clinic. Physicians had no access to the patient's answer sheets.
Intra-Class Correlations (ICC) were used to assess the consistency or conformity of the measures made by multiple observers, and Bland Altman graphs plotted the strength of concordance for each patient against average ratings for both physicians and patients.
Results show physicians rated their patients' health-related quality of life higher than patients, both for the mental component score (P<0.0001) and physical component score (p=0.001). Both the ICCs and Bland-Altman graphs showed unsatisfactory concordance. In the regression analyses, depression was significantly associated with discord in the mental component score (=-0.94; p<0.001) and the physical component score (=-4.13; p<0.002). Furthermore, sleeping disorders were associated with discord in the mental component score (=-4.13; p<0.002) and physical activity with discord in the physical component score (=-1.47; p=0.006).
"When one considers the importance placed on quality of life in the AF literature these levels of discordance between physicians and patients are surprisingly large. They underline the need for physician to be trained to recognize depression in patients and for the introduction of systematic screening for depression in all AF clinics," says Ladwig, from the Helmholtz Centre, Munich, Germany.
Future studies should explore whether interventions such as physician training and screening, improve both quality of life and t
|Contact: Jacqueline Partarrieu|
European Society of Cardiology