Depressed mood amplifies heart-related symptoms in persistent and paroxysmal atrial fibrillation patients: a longitudinal analysis--data from the German Competence Network on Atrial Fibrillation

Aims: There is limited evidence of an association between the burden of atrial fibrillation (AF)-related symptoms and depressed mood (DM). We used follow-up data from two randomized trials to relate AF symptoms, perceived AF burden, and DM.

Methods and results: Baseline data on 319 persistent AF patients from the Flec-SL trial and 244 paroxysmal AF patients from the ANTIPAF trial were available. Data on 400 patients were available at 6-month follow-up. Depressed mood was measured using the major depression inventory, AF symptoms using the AF Symptom Checklist. Generalized estimating equation models were used to assess the association between symptom burden and DM. At baseline, 194 patients (35.2%) reported DM, 294 (52.2%) reported severe AF symptom burden. Burden from all symptoms except fainting was significantly elevated in patients with DM. An improvement in DM from baseline to follow-up was associated with reduced symptom burden [odds ratio (OR) = 2.06; 95% confidence interval (CI): 1.22-3.51]. Patients with DM had three-fold increased odds of severe symptom burden after adjustment for perceived AF-frequency and -duration, sex, and chronic obstructive pulmonary disorder (COPD) (OR = 3.19; 95% CI: 2.65-8.45). Women reported significantly more severe symptom burden than men (OR = 1.44; 95% CI: 1.36-1.95). Uneasiness, nausea, and shortness of breath were most strongly associated with DM. The effect of DM on nausea was more pronounced for men (P(interaction) = 0.041). Perceived AF-frequency and -duration were not associated with DM (P = 0.717 and 0.236, respectively).

Conclusion: Depressed mood is associated with AF symptom burden over 6 months after adjustment for perceived frequency and duration of AF episodes, COPD, and sex.