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• W1991111130 abstract "Atrial fibrillation (AF) is the most common chronic arrhythmia [[1]Thrall G. Lane D. Carroll D. Lip G.Y.H. Quality of life in patients with atrial fibrillation: a systematic review.Am J Med. 2006; 119: e1-e19PubMed Google Scholar]. Lots of studies focused on the impact of therapeutic strategies on reducing morbidity and mortality in patients with AF [2Wyse D.G. Waldo A.L. DiMarco J.P. et al.A comparison of rate control and rhythm control in patients with atrial fibrillation.N Engl J Med. 2002; 347: 1825-1833Crossref PubMed Scopus (3617) Google Scholar, 3Fuster V. Ryden L.E. Cannom D.S. et al.ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation.Circulation. 2006; 114: e257-e354Crossref PubMed Scopus (2003) Google Scholar, 4Jenkins L.S. Brodsky M. Schron E. et al.Quality of life in atrial fibrillation: The Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study.Am Heart J. 2005; 149: 112-120Abstract Full Text Full Text PDF PubMed Scopus (200) Google Scholar]. However, any therapeutic interventions to control rhythm or rate in patients with AF have not shown to have an impact on mortality or morbidity [[2]Wyse D.G. Waldo A.L. DiMarco J.P. et al.A comparison of rate control and rhythm control in patients with atrial fibrillation.N Engl J Med. 2002; 347: 1825-1833Crossref PubMed Scopus (3617) Google Scholar]. Thereafter, it has been suggested that reduction of symptoms and improvement of Quality of Life (QOL) might be better therapeutic target for the management of AF [[3]Fuster V. Ryden L.E. Cannom D.S. et al.ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation.Circulation. 2006; 114: e257-e354Crossref PubMed Scopus (2003) Google Scholar]. In the psychosocial aspects, individual differences in personality can affect the QOL. Chronic psychological distress status, like type D personality, has been known to be associated with poor QOL, morbidity and mortality in patients with coronary heart disease, heart failure and peripheral artery disease [5Pedersen S.S. Herrmann-Lingen C. De Jonge P. Scherer M. Type D personality is a predictor of poor emotional quality of life in primary care heart failure patients independent of depressive symptoms and New York Heart Association functional class.J Behav Med. 2010; 33: 72-80Crossref PubMed Scopus (35) Google Scholar, 6Denollet J. Sys S.U. Brutsaert D.L. Personality and mortality after myocardial infarction.Psychosom Med. 1995; 57: 582-591Crossref PubMed Scopus (234) Google Scholar, 7Aquarius A.E. Denollet J. Hamming J.F. De Vries J. Role of disease status and type D personality in outcomes in patients with peripheral arterial disease.Am J Cardiol. 2005; 96: 996-1001Abstract Full Text Full Text PDF PubMed Scopus (69) Google Scholar]. However, little is known about the relationship between personality and QOL in patients with AF. Thus, we aimed to find out the determinants of QOL including type D personality in AF patients. Between March 2012 and July 2012, eligible 108 patients who were diagnosed as AF were analyzed. All patients completed interview about QOL and type D personality, and were divided into 4 groups based on the degree of QOL using the Medical Outcomes Study Short Form-12 (SF-12) scores which was consisted of mental component summary (MCS) scores and physical component summary (PCS) scores. The mean value of each of the scores was considered 50 in the general population. The higher scores are at each component, the better QOL is. [[8]Ware J.E.J. Kosinski M. Keller Susan D. A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity.Med Care. 1996; 34: 220-233Crossref PubMed Scopus (12025) Google Scholar]. Patients were divided into high and low MCS score groups by a cut off value of 50. Likewise, based on PCS scores of 50, patients were divided into high and low PCS score groups. Successful therapeutic intervention of AF was defined that sinus rhythm was maintained or ventricular rate was controlled as 60 to 100 beat per minute at rest. The methods of unpaired Student's t-test, chi-square test, multivariate logistic regression analysis were used (SPSS for window 18.0). The mean age was 60.4 ± 8.8 years and 53 (54.1%) patients had type D personality. Baseline characteristics are summarized in Table 1. Male gender was more common in the high than in the low MCS score group and the same as in the high than in the low PCS score group. There were no differences in chronic underlying disease between the high and low MCS score groups and between the high and low PCS score groups. In echocardiographic findings, left atrium was dilated in all groups, while left ventricular ejection fraction was preserved. The applied therapeutic strategy was also similar between the high and low MCS groups and between the high and low PCS score groups. Type D personality was more prevalent in the low MCS score group, whereas no difference between the high and low PCS score group.Table 1Baseline characteristics.MCS (n = 108)PCS (n = 108)High (n = 54)Low (n = 54)p ValueHigh (n = 41)Low (n = 67)p ValueDemographic features Age, years60.35 ± 8.560.54 ± 9.20.91460.88 ± 7.760.18 ± 9.50.102 Male, n (%)47 (87)33 (61)0.00435 (85)45 (67)0.043 Smoking, n (%)14 (26)18 (33)0.37911 (27)21 (31)0.652Personality type Type D, n (%)19 (35)37 (69)0.00118 (44)38 (57)0.236Chronic underlying disease, n (%) Hypertension3 (6)2 (4)1.00011 (27)22 (33)0.667 Diabetes mellitus1 (2)1 (2)1.0005 (12)13 (19)0.429 Hyperlipidemia2 (4)1 (2)0.4866 (15)3 (4)0.077 Cerebrovascular accidents3 (6)4 (7)1.0002 (5)1 (1)0.556 Coronary artery disease1 (2)0 (0)0.4292 (5)2 (3)0.634 Dilated cardiomyopathy1 (2)4 (7)0.3632 (5)3 (4)1.000 None21 (38)18 (33)0.68916 (39)23 (34)0.682NT-proBNP, pg/mL608.6 ± 667.8581.3 ± 811.40.577593.8 ± 621.6594.8 ± 814.00.658Echocardiography Left ventricular EF, (%)61.7 ± 7.364.0 ± 8.00.88563.1 ± 7.762.6 ± 7.80.394 LA diameter, (mm)45.3 ± 7.842.1 ± 7.40.80243.8 ± 6.543.7 ± 8.40.300Applied therapeutic strategy Rate control, n (%)29 (54)26 (48)0.70021 (51)32 (48)0.843 Rhythm control, n (%)25 (46)28 (52)0.70020 (49)35 (52)0.843 Success, n (%)48 (89)37 (68)0.01739 (95)46 (69)0.001MCS = mental component score, PCS = physical component score, NT-proBNP = N-terminal pro-B-type natriuretic peptide, EF = Ejection fraction, and LA = Left atrium. Open table in a new tab MCS = mental component score, PCS = physical component score, NT-proBNP = N-terminal pro-B-type natriuretic peptide, EF = Ejection fraction, and LA = Left atrium. In multivariate analysis, independent predictors for low MCS scores were female gender (Odds ratio [OR], 0.31; 95% confidence interval [CI], 0.11 to 0.85; p = 0.020) and type D personality (OR, 0.25; 95% CI, 0.11 to 0.58; p = 0.001). Successful achievement of treatment target of AF was independent predictor for high MCS (OR, 2.96; 95% CI, 1.00 to 8.74; p = 0.040) scores as well as PCS scores (OR, 7.61; 95% CI, 1.64 to 35.36; p = 0.010) (Table 2).Table 2Multivariate logistic regression analysis for MCS and PCS.MCSPCSOR (95% CI)p ValueOR (95% CI)p ValueType D personality0.25 (0.11–0.58)0.0010.56 (0.23–1.39)0.216Female gender0.31 (0.11–0.85)0.0230.48 (0.16–1.47)0.200Success of applied therapeutic strategy2.96 (1.00–8.74)0.0497.61 (1.64–35.36)0.010Coronary artery disease0.32 (0.02–4.93)0.4170.96 (0.11–7.90)0.115Hyperlipidemia1.09 (0.22–5.28)0.9180.23 (0.04–1.23)0.052Hypertension1.29 (0.46–3.61)0.6331.56 (0.56–4.36)0.558Age > 65 years1.44 (0.52–4.00)0.4870.80 (0.30–2.14)0.296Cerebrovascular accidents1.71 (0.05–25.21)0.9991.08 (0.05–23.86)0.059Diabetes mellitus1.72 (0.49–6.02)0.3961.29 (0.36–4.62)0.358MCS = mental component score, and PCS = physical component score. Open table in a new tab MCS = mental component score, and PCS = physical component score. The present study suggested that QOL in AF patients was determined by gender, personality type in addition to successful achievement of selected therapeutic goal. Consistent with the previous reports, the present study also showed that female gender was an independent predictor for poor MCS scores [9Rienstra M. Van Veldhuisen D.J. Hagens V.E. et al.Gender-related differences in rhythm control treatment in persistent atrial fibrillation: data of the Rate Control Versus Electrical Cardioversion (RACE) study.J Am Coll Cardiol. 2005; 46: 1298-1306Abstract Full Text Full Text PDF PubMed Scopus (160) Google Scholar, 10Paquette M. Roy D. Talajic M. et al.Role of gender and personality on quality-of-life impairment in intermittent atrial fibrillation.Am J Cardiol. 2000; 86: 764-768Abstract Full Text Full Text PDF PubMed Scopus (138) Google Scholar, 11Dagres N. Nieuwlaat R. Vardas P.E. et al.Gender-related differences in presentation, treatment, and outcome of patients with atrial fibrillation in Europe: a report from the Euro Heart Survey on Atrial Fibrillation.J Am Coll Cardiol. 2007; 49: 572-577Abstract Full Text Full Text PDF PubMed Scopus (290) Google Scholar]. Gender difference of QOL in patients with AF might be explained in part by a high susceptibility to psychosocial and physical impairment of female genders to disease. Individuals with negative affectivity and social inhibition might have type D personality and be vulnerable to chronic distress [[12]Denollet J. Sys S.U. Stroobant N. Rombouts H. Gillebert T.C. Brutsaert D.L. Personality as independent predictor of long-term mortality in patients with coronary heart disease.Lancet. 1996; 347: 417-421Abstract Full Text PDF PubMed Scopus (528) Google Scholar]. It is associated with an increased risk of impaired QOL, morbidity and mortality in conjunction with various cardiovascular diseases [[6]Denollet J. Sys S.U. Brutsaert D.L. Personality and mortality after myocardial infarction.Psychosom Med. 1995; 57: 582-591Crossref PubMed Scopus (234) Google Scholar]. According to Nancy Frasure-Smith et al., psychological characteristic as referred to anxiety sensitivity was important to select treatment strategy in patient with AF and congestive heart failure [[13]Frasure-Smith N. Lespérance F. Talajic M. et al.Anxiety sensitivity moderates prognostic importance of rhythm-control versus rate-control strategies in patients with atrial fibrillation and congestive heart failure clinical perspective insights from the atrial fibrillation and congestive heart failure trial.Circ Heart Fail. 2012; 5: 322-330Crossref PubMed Scopus (24) Google Scholar]. If the patient had high anxiety sensitivity, the rhythm control group showed better prognosis than rate control group. The result of that study was different with the present study that any therapeutic intervention might be no impact of QOL. However, it is consistent with our results which emphasized the importance of personal characteristics should be considered to treat AF. In the aspect of therapeutic strategy, rhythm control or rate control exhibits no significant difference in morbidity and mortality. Rather, it has been suggested that the reduction of symptoms and the improvement in QOL might be pivotal factors when choosing AF therapies [[3]Fuster V. Ryden L.E. Cannom D.S. et al.ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation.Circulation. 2006; 114: e257-e354Crossref PubMed Scopus (2003) Google Scholar]. The present study also showed that any therapeutic strategies were not associated with MCS or PCS scores. However, successful achievement of applied therapeutic strategy was associated with better QOL. From these results, it can be suggested that successful achievement of applied therapeutic strategy might be the better therapeutic options rather than rhythm or rate control themselves. Chronic underlying medical conditions, such as diabetic mellitus, hypertension, cerebrovascular accidents, and hyperlipidemia have been well known risk factors of cardiovascular disease. Considering their potential impact, they might worsen the QOL in patients with cardiovascular disease as well as AF. However, the present study showed that they did not have any influences on QOL in patients with AF. These might be explained that relative small sample size in the present study could not reflect well their effects, and further researches are required about the relationship between chronic underlying disease and QOL in patients with AF. The present study had some limitations. First, sample size was small which could cause selection bias. Second, interview questionnaires were translated from English to Korean. Therefore, patients might not have a clear meaning of the questionnaires. In conclusion, female gender and type D personality were associated with poor mental QOL, whereas successful achievement of applied therapeutic strategy was associated with the better mental and physical QOL in AF patients." @default.
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• W1991111130 title "Determinants of quality of life in patients with atrial fibrillation" @default.
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