Atrial fibrillation, quality of life and distress: a cluster analysis of cognitive and behavioural responses

Abstract

Purpose Few studies have examined specific cognitive and behavioural responses to symptoms, which may impact health-related outcomes, in conjunction with illness representations, as outlined by the Common-Sense-Model. Patients with atrial fibrillation (AF) report poor quality-of-life (QoL) and high distress. This cross-sectional study investigated patterns/clusters of cognitive and behavioural responses to illness, and illness perceptions, and relationships with QoL, depression and anxiety. Methods AF patients (N = 198) recruited at cardiology clinics completed the AF-Revised Illness Perception Questionnaire, Atrial-Fibrillation-Effect-on-Quality-of-Life Questionnaire, Patient Health Questionnaire-8 and Generalized Anxiety Disorder Questionnaire. Cluster analysis used Ward’s and K-means methods. Hierarchical regressions examined relationships between clusters with QoL, depression and anxiety. Results Two clusters of cognitive and behavioural responses to symptoms were outlined; (1) ‘high avoidance’; (2) ‘low symptom-focussing’. Patients in Cluster 1 had lower QoL (M = 40.36, SD = 18.40), greater symptoms of depression (M = 7.20, SD = 5.71) and greater symptoms of anxiety (M = 5.70, SD = 5.90) compared to patients in Cluster 2 who had higher QoL (M = 59.03, SD = 20.12), fewer symptoms of depression (M = 3.53, SD = 3.56) and fewer symptoms of anxiety (M = 2.56, SD = 3.56). Two illness representation clusters were outlined; (1) ‘high coherence and treatment control’, (2) ‘negative illness and emotional representations’. Patients in Cluster 2 had significantly lower QoL (M = 46.57, SD = 19.94), greater symptoms of depression (M = 6.12, SD = 5.31) and greater symptoms of anxiety (M = 4.70, SD = 5.27), compared with patients in Cluster 1 who had higher QoL (M = 61.52, SD = 21.38), fewer symptoms of depression (M = 2.85, SD = 2.97) and fewer symptoms of anxiety (M = 2.16, SD = 3.63). Overall, clusters of cognitive and behavioural responses to symptoms, and illness perceptions significantly explained between 14 and 29% of the variance in QoL, depression and anxiety. Conclusion Patterns of cognitive and behavioural responses to symptoms, and illness perceptions are important correlates of health-related outcomes in AF patients.

Quality of life among patients with atrial fibrillation: A theoretically-guided cross-sectional study

“…These results suggest the importance of considering multidimensional interventions to support HRQoL among patients with AF, and potentially considering targeting different interventions for specific groups (e.g., those high/low in AF knowledge). Indeed, researchers have recently been observing the diversity/variability in AF populations [ 44 ], suggesting that in future we may need to move beyond assuming linearity in theorizing the relationships between personal characteristics and HRQoL.…”

Characteristics associated with poor atrial fibrillation-related quality of life in adults with atrial fibrillation

“…AF symptoms including heart palpitations, chest pain, and shortness of breath can often be debilitating, hence, individuals with AF are at an increased risk for restrictive physical activity, major bleeding events, and a higher number of comorbid conditions, when compared with those without AF 3–6 . Further, the symptoms and consequences of AF can lead to poor AF-related quality of life (AFQoL) 5,7,8 . AFQoL questionnaires can be used to understand the impact of AF on patients’ lives and serve as an important benchmark when considering different treatment choices 3 …”

“…[3][4][5][6] Further, the symptoms and consequences of AF can lead to poor AF-related quality of life (AFQoL). 5,7,8 AFQoL questionnaires can be used to understand the impact of AF on patients' lives and serve as an important benchmark when considering different treatment choices. 3 As AF primarily affects adults aged 65 years and older, it is important to understand how certain geriatric characteristics, such as frailty and cognitive impairment, are related to poor AFQoL.…”

Sociodemographic, Clinical and Geriatric Characteristics Associated with Poor Atrial Fibrillation-Related Quality of Life in Older Adults with Atrial Fibrillation: A cross-sectional study

“…AF symptoms including heart palpitations, chest pain, and shortness of breath can often be debilitating, hence, individuals with AF are at an increased risk for restrictive physical activity, major bleeding events, and a higher number of comorbid conditions, when compared to those without AF [3][4][5]. Further, the symptoms and consequences of AF can lead to poor AFrelated quality of life (AFQoL) [5][6][7]. AFQoL questionnaires can be used to understand the impact of AF on patients' lives and serve as an important benchmark when considering different treatment choices [3].…”