Discrepancy in recognition of symptom burden among patients with atrial fibrillation

Abstract Background 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-referred AF 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-reported AF 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  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.