New Study Shows Gender, Age, and Mood Disorders Affect How Patients Perceive Their Atrial Fibrillation Symptoms

First-of-its-kind study published in HeartRhythm assesses various factors that lead to inaccurate detection of the frequency and duration of atrial fibrillation episodes

April 01, 2015

Media Contact

Ken Demith
Heart Rhythm Society

WASHINGTON – A new study shows how specific factors such as gender, age and mood disorders like anxiety and depression can lead patients with atrial fibrillation (AF) to inaccurately assess their heart rhythm. The study, published in the April edition of HeartRhythm,the official journal of the Heart Rhythm Society (HRS), is the first-of-its-kind to evaluate demographics, health status and heart monitor data to identify specific factors that predict inaccuracies. Patients with persistent AF, women, older adults and those diagnosed with anxiety or depression were most likely to have inaccurate perceptions by either over-or-underestimating their AF symptoms.

Demographic and health status data were captured via questionnaires completed by 458 outpatients with documented AF. All patients wore continuous heart monitors for one week. Patients estimated the length and frequency of their AF episodes by completing the AF Symptom Severity questionnaire. Patient perceptions were compared to AF burden based on heart monitor results. Significant overestimators believed they were in near-continuous AF when their AF burden was less than 10 percent, while significant underestimators believed they had little to no AF when their AF burden was greater than 90 percent. 

Fifteen percent of patients were found to be significant over-or-underestimators. Psychological comorbidities specifically anxiety and depression strongly predicted overestimating (5 percent), with anxiety being the stronger correlate of the two. Participants with persistent AF, female and older adults (mean 72.5 years old) were more prone to underestimating (9.8 percent) the length and frequency of their AF episodes.

“Oftentimes symptoms of AF can be difficult for patients to characterize. Some patients may have symptoms they think are due to AF, when in fact they may have another cause. Such misperceptions make it challenging to find appropriate and effective treatment options. Therefore, it’s crucial for patients to learn to check their pulse, learn what’s normal versus abnormal, and truly understand their heart rhythm,” stated co-lead author Anil Gehi, MD, FHRS, Associate Professor of Medicine / Cardiology, UNC Center for Heart & Vascular Care. “Our study results reinforce the importance of bettering patient understanding of AF. Improving communication with patients and educating them on the signs and symptoms of AF episodes could allow for a faster, more targeted treatment approach that would greatly enhance the quality of patient care.”

AF is the most common heart arrhythmia and affects more than 2.5 million American adults. The prevalence of AF is increasing rapidly, with projections to double by 2035 and to increase to 8 million by 2050[1] . This study specifically sheds light on the comorbidities and features of AF that affect the presence of symptoms. HRS works throughout the year to increase public knowledge of AF, including its symptoms, warning signs, and available treatment options.The Heart Rhythm Society has nearly 20 patient information sheets available , with several translated into Spanish, Chinese, or Portuguese. Additional  resources for physicians and patients are available online at .

[1] Naccarelli GV, Varker H, Lin J, Shulman KL. Increasing prevalence of atrial fibrillation and flutter in the United States. Am J Cardiol 2009; 104:1534-1539.

About the Heart Rhythm Society

The Heart Rhythm Society is the international leader in science, education, and advocacy for cardiac arrhythmia professionals and patients, and the primary information resource on heart rhythm disorders. Its mission is to improve the care of patients by promoting research, education, and optimal health care policies and standards. Incorporated in 1979 and based in Washington, DC, it has a membership of more than 6,000 heart rhythm professionals in more than 72 countries around the world. For more information, visit

About the HeartRhythm Journal

HeartRhythm provides rapid publication of the most important science developments in the field of arrhythmias and cardiovascular electrophysiology (EP). As the official journal of the Heart Rhythm Society, HeartRhythm publishes both basic and clinical subject matter of scientific excellence devoted to the EP of the heart and blood vessels, as well as therapy. The journal is the only EP publication serving the entire electrophysiology community from basic to clinical academic researchers, private practitioners, technicians, industry and trainees. HeartRhythm has an impact factor of 4.866 (as of 2016) and ranks 23rd out of 114 cardiovascular medicine journals worldwide by the Institute for Scientific Information, remaining the number one specialty journal in cardiology. It is also the official publication of the Cardiac Electrophysiology Society.