Published online before print March 31, 2009, doi: 10.1161/CIRCEP.108.812347
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Original Articles |
Validation of a New Simple Scale to Measure Symptoms in Atrial Fibrillation
The Canadian Cardiovascular Society Severity in Atrial Fibrillation Scale
From the Division of Cardiology (P.D., S.S.O.), St Michael’s Hospital and the University of Toronto, Toronto, Ontario; the Division of Cardiology (P.G.G., D.R.), Montreal Heart Institute and the Université de Montréal, Montreal, Quebec; the Division of Cardiology (C.R.K.), St Paul’s Hospital and the University of British Columbia, Vancouver, British Columbia; the Division of Cardiology (E.C.), Sunnybrook and Women’s College Health Sciences Centre and the University of Toronto, Toronto, Ontario; Libin Cardiovascular Institute of Alberta (A.M.G., L.B.M., D.G.W.), Department of Cardiac Sciences, University of Calgary and Calgary Health Region, Calgary, Alberta; Alberta Heritage Foundation for Medical Research (A.M.G.); the Division of Cardiology (A.C.S.), London Health Sciences Centre and University of Western Ontario, Calgary Health Region (M.S.R.), London, Ontario, Canada.
Correspondence to Paul Dorian, MD, St Michael’s Hospital, Division of Cardiology, 30 Bond St, 6-050Q, Toronto, Ontario, M5B 1W8 Canada. E-mail dorianp{at}smh.toronto.on.ca
Received August 1, 2008; accepted January 14, 2009.
Background— Atrial fibrillation (AF) is commonly associated with impaired quality of life. There is no simple validated scale to quantify the functional illness burden of AF. The Canadian Cardiovascular Society Severity in Atrial Fibrillation (CCS-SAF) scale is a bedside scale that ranges from class 0 to 4, from no effect on functional quality of life to a severe effect on life quality. This study was performed to validate the scale.
Methods and Results— In 484 patients with documented AF (62.2±12.5 years of age, 67% men; 62% paroxysmal and 38% persistent/permanent), the SAF class was assessed and 2 validated quality-of-life questionnaires were administered: the SF-36 generic scale and the disease-specific AFSS (University of Toronto Atrial Fibrillation Severity Scale). There is a significant linear graded correlation between the SAF class and measures of symptom severity, physical and emotional components of quality of life, general well-being, and health care consumption related to AF. Patients with SAF class 0 had age- and sex-standardized SF-36 scores of 0.15±0.16 and –0.04±0.31 (SD units), that is, units away from the mean population score for the mental and physical summary scores, respectively. For each unit increase in SAF class, there is a 0.36 and 0.40 SD unit decrease in the SF-36 score for the physical and mental components. As the SAF class increases from 0 to 4, the symptom severity score (range, 0 to 35) increases from 4.2±5.0 to 18.4±7.8 (P<0.0001).
Conclusions— The CCS-SAF scale is a simple semiquantitative scale that closely approximates patient-reported subjective measures of quality of life in AF and may be practical for clinical use.
Key Words: atrial fibrillation • quality of life
CLINICAL PERSPECTIVE
Michael E. Cain, MD, was Guest Editor for this article.The online-only Data Supplement is available at http://circep.ahajournals.org/cgi/content/full/CIRCEP.108.812347/DC1.
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