Predictors of symptoms and psychological distress in patients with recurrent symptomatic atrial fibrillation.

摘要

Atrial fibrillation (AF) is a chronic life complicating illness associated with impaired health-related quality of life (HRQOL). Mechanisms influencing symptoms, promoting psychological distress, and impairing HRQOL in people with AF are poorly understood. Leventhal's Common Sense Model guided this descriptive, predictive study of patients with recurrent symptomatic AF to (1) describe their illness representation and (2) coping strategies, (3) identify illness representations, coping strategies, and psychological responses predicting symptom characteristics (frequency, severity, bothersomeness) and, (4) identify illness representations, coping strategies, and symptom characteristics predicting psychological distress. Subjects (N = 207) 64 (12.3) years, and 56% male completed the Illness Perception Questionnaire-Revised, COPE Inventory, Profile of Mood States, Symptom Checklist-Frequency and Severity, and Bothersome Symptoms Rating. Univariate analysis was used to describe illness representation and coping strategies. Hierarchical regression analyses identified predictors of symptoms and psychological distress. Subjects attributed fatigue, dyspnea, loss of strength, dizziness, and sleep problems to AF and perceived AF as chronic with serious consequences. Subjects attributed AF to stress, age, and heredity and reported AF induced worry and feelings of depression, anxiety and fear. Subjects' most frequently used coping strategies were planning, acceptance, action, and seeking instrumental and emotional social support. Fatigue was the strongest predictor of symptom characteristics with perceiving AF as unpredictable and cyclic contributing to more symptom severity and bothersomeness. Psychological distress was predicted by perceiving one's AF as having serious consequences, caused by psychological factors, perceiving a poor understanding of AF, coping by focusing on emotion, and greater symptom frequency. The findings in this study contribute to further understanding of patients' psychological response to AF and their coping strategies. Findings suggest that interventions designed to modify illness representations, to improve understanding of AF, and coach for more therapeutic coping strategies may reduce psychological distress in patients with recurrent symptomatic AF.