Browsing School, Graduate by Author "Akintade, Bim Fola"
Psychosocial, Clinical, and Demographic Predictors of Quality of Life in Pharmacologically Managed and Catheter Ablation Atrial Fibrillation and Atrial Flutter PatientsAkintade, Bim Fola; Thomas, Sue Ann, 1947- (2011)Background: Atrial fibrillation (AF) and atrial flutter (AFL) are the most diagnosed symptomatic cardiac arrhythmias in the United States. Much is known about the Quality of Life (QoL) of AF/AFL patients, but no published study specifically examined the impact of ablation procedures on the QoL of AF/AFL patients with comorbid depression and/or anxiety. Purpose: This study evaluates the contributions of psychosocial, clinical, and demographic variables to QoL in pharmacologically managed and pre-ablated AF and AFL patients, and the change in QoL of these patients after successful catheter ablation procedures. Methods: This was a prospective hypothesis-generating quasi-experimental study with a control group. The study consisted of 75 pharmacologically managed AF/AFL patients and 75 consecutive individuals scheduled for catheter ablation procedures for AF/AFL at the Washington Hospital Center and University of Maryland Medical Center Arrhythmia Center's from April 2010 to March 2011. Hypotheses were tested with cross tabulations, t-tests, ANOVAs, repeated measures ANOVAs, and linear regression analyses. The instruments utilized in the current study include the Beck Depression Inventory II to measure depression, the STAI to measure anxiety, and the subscales of SF-36v2, and SSCL to evaluate QoL. Results: Female and younger AF/ AFL patients have worse QoL, and elevated baseline depressive and anxiety symptoms were significant predictors of baseline QoL. After successful catheter ablation procedures, AF/ AFL patient's demonstrated significant improvements in QoL and depressive and anxiety symptoms compared to control patients over 1 month. Results also demonstrated that females, elevated baseline depressive symptoms, and baseline scores on QoL questionnaire subscales were significant predictors of change in QoL over 1 month. Conclusion: Depression, anxiety, and female gender should be considered as risk factors identifying patients who may require additional evaluation and treatment efforts to manage their cardiac conditions. The implementation of early depressive and anxiety symptom screening may provide information for cost effective and comprehensive approaches to the management of AF/ AFL patients.