Discrepancy in recognition of symptom burden among patients with atrial fibrillation

Yoshinori Katsumata, Takehiro Kimura, Shun Kohsaka, Nobuhiro Ikemura, Ikuko Ueda, Taishi Fujisawa, Kazuaki Nakajima, Takahiko Nishiyama, Yoshiyasu Aizawa, Takahiro Oki, Masahiro Suzuki, Paul A. Heidenreich, Keiichi Fukuda, Seiji Takatsuki

Research output: Contribution to journalArticlepeer-review

9 Citations (Scopus)


Our aim was to investigate the variability in physician recognition of atrial fibrillation (AF)-related symptoms, which greatly contributes to the management of AF patients. Methods and Results: A total of 1493 newly-referredAF patients (67 ± 11 y/o, 1057 men) consecutively registered in an outpatient-based Japanese multicenter database (KiCS-AF) from September 2012 to December 2016 were analyzed. Self-reportedAF symptom burden was assessed via symptom and daily activities domains within the Atrial Fibrillation Effect on QualiTy-of-life (AFEQT) questionnaire. Physician symptom under-recognition (UR) was defined as no subjective complaints recorded in the medical records despite AFEQT score of <80; and physician's apparent over-recognition (OvR) was defined as documentation of subjective complaints despite total AFEQT score of ≥80. There was poor agreement between patient-reported and physicians-estimated symptom burden (kappa 0.28, 95% CI 0.23 to 0.33). In the logistic regression analysis, age> 75 (odds ratio [OR], 1.72; 95% confidence interval [CI], 1.13–2.62), male sex (OR, 1.82; 95% CI, 1.22–2.74), and persistent/permanent AF (OR 2.54/3.36; CI, 1.63–3.99/1.91–5.89, respectively) were predictors of UR. Conversely, heart failure (OR, 2.46; 95% CI, 1.44–4.25) and treatment in an ablation facility (OR, 1.43; 95% CI, 1.02–2.02) were associated with greater odds of OvR in addition to age, sex, and type of AF. Conclusions: Discordance in recognition of AF symptom burden by physicians was frequent in AF patients seen in outpatient management and involved both patient- and physician-related factors.

Original languageEnglish
Pages (from-to)240-249
Number of pages10
JournalAmerican heart journal
Publication statusPublished - 2020 Aug

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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