By Dr Jonathan Shurlock
Edited by Dr Saadia Aslam
The symptomatic burden of atrial fibrillation (AF) is well documented, with a known impact on quality of life and an increase in healthcare interaction and intervention. Dr Josefin Särnholm’s team has explored the role of fear of symptoms and avoidance behaviour on disability in AF and the potential role of cognitive behavioural therapy (CBT) to address these.
127 patients with symptomatic paroxysmal AF were identified, with at least European Heart Rhythm Association IIb symptom severity. Participants were randomised AF focussed CBT (n=65) or standard AF education group (n=62). CBT was delivered via an online forum, guided by a therapist, and lasted 10 weeks. The primary outcome measure was AF-related quality of life, measured using the AF Effect on Quality of Life summary score. This was assessed at baseline, immediately post-treatment and at 3 month follow up.
The AF-CBT group were shown to have a significant improvement in AF-specific quality of life, with an improvement of 15.0 points (95% CI: 10.1-19.8; p<0.001) and a reduction in utilisation of health care by 56% (95% CI: 22-90; p = 0.025), compared to baseline. There was no difference in AF burden as measured by 5-day ECG monitoring, in either group or at any time point.
The authors highlight the potential role for the use of CBT in improving AF-specific quality of life and reduction of healthcare usage, in those with symptomatic AF. The need for replication of these findings is acknowledged. The study is limited by the lack of blinding necessitated by the mode of intervention. Dr Särnholm has demonstrated the potential of an additional tool in the management of AF related symptom burden.
See the full study here: https://www.jacc.org/doi/full/10.1016/j.jacc.2023.04.044
