Arrhythmias and conduction disturbances
Role of gender and personality on quality-of-life impairment in intermittent atrial fibrillation

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Abstract

Patients with atrial fibrillation (AF) report impaired health-related quality of life (QOL). Differences between men and women with AF have not been described and personality attributes such as somatization (tendency to amplify benign bodily sensations) may mediate potential gender differences in QOL. Patients with AF (n = 264, 59% men) who participated in the Canadian Trial of Atrial Fibrillation (n = 403) completed validated QOL questionnaires at baseline, 3 months, and 12 months after antiarrhythmic drug treatment. Women were significantly older than men and a greater proportion had hypertension, but other cardiac variables did not differ between women and men. At baseline, after controlling for significant clinical and demographic factors, women reported worse physical health (p = 0.002) and functional capacity (p <0.001), but not mental health or general well-being. Women also had more frequent and severe cardiac symptoms than men (both p <0.001). Physical health improved significantly from baseline to 3 months for women (p = 0.002), but not for men (p = 0.066). Conversely, mental health improved for men (p = 0.007), but not for women. Cardiac symptom frequency and severity improved over time for women and men (all p <0.001). Tendency to somatize predicted poor QOL, and women had higher scores than men (p = 0.023). However, after controlling for somatization, women still had worse physical function, functional capacity, and symptom burden than men. Independent of cardiac disease severity and age, women with AF had significantly more impaired QOL than men, specifically on domains related to physical rather than emotional functioning. Personality attributes may have a role in influencing QOL outcomes.

Section snippets

Methods

The Canadian Trial of Atrial Fibrillation was a double-blinded, randomized, multicenter study of the effect of amiodarone versus sotalol or propafenone in preventing AF recurrences in patients with a history of paroxysmal or persistent AF. The details of the protocol have previously been published.15, 16 Consecutive outpatients participating in the trial, >18 years old, who could read English or French and had no cognitive or sensory limitations, were asked to participate and were given

Results

A total of 294 patients with AF (82% of patients eligible for QOL study) returned completed baseline questionnaires; 264 (73%) had complete baseline and 3-month data, and 170 (47%) had baseline, 3-, and 12-month data. The group with complete data at the baseline and 3-month assessment provided data for analyses, as inclusion of the 12-month results did not change any of the findings. There were no significant changes in any QOL variable from the 3- to 12-month assessment. Inclusion of the

Discussion

The main result of this study is that in a population of patients with newly diagnosed, symptomatic AF, QOL is significantly more impaired in women than men despite comparable disease severity. These results are consistent with previous findings of greater physical and psychological debilitation and worse QOL in women after a cardiac event.8, 23 However, the only other study of arrhythmias that incorporated a gender analysis in the results revealed that there were no gender differences in

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    This study was supported by a grant from Wyeth-Ayerst Canada Inc., Montreal, Quebec; and an operating grant from the Medical Research Council of Canada, Ottowa, Ontario.

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