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Health related quality of life (QoL) is significantly impaired in patients with atrial fibrillation (AF) compared with healthy controls. There are various instruments to assess QoL in patients with AF. University of Toronto Atrial Fibrillation Severity Scale (AFSS) is a disease-specific health related QoL questionnaire designed for patients with AF. The aim of this study is to determine the reliability and validity of the Turkish version of the University of Toronto AFSS.
University of Toronto AFSS consists of 19 items combined into 3 parts to measure total AF burden, health care utilization and severity of the AF-related symptoms. AFSS and short form-36 (SF-36) were completed by 80 patients with documented AF. The Canadian Cardiovascular Society Severity in Atrial Fibrillation (SAF) scale and European Heart Association (EHRA) scale were also assessed by the treating physicians. To assess test re-test reliability AFSS were re-administered to 28 clinically stable patients at 1 month follow-up. Internal consistency reliability, test re-test reproducibility and construct validity were evaluated.
Mean age of the patients was 62.7±11.4 years and 57.5% were male. Paroxysmal AF was present in 32% of patients, and 20% were on antiarrhythmic drugs to maintain sinus rhytm. All patients completed AFSS in <5 minutes. Outcome scores of the Turkish version of AFSS showed strong correlations (r>0.60) with theoretically related SF-36 domains. Additionally, AFSS outcome scores showed a linear correlation with the SAF and EHRA scores (Table 1 and 2). Total AF burden and symptom severity were strongly correlated with the patient's SAF or EHRA class (Table 1 and 2). Cronbach's alpha values for internal consistency (Table 3) were consistent and similar with the English version of the AFSS. Intraclass correlation coefficients for reproducibility exceeded 0.80 for every item.
Convergent-divergent and known-groups validity and reliability were established for the Turkish version of the University of Toronto AFSS.
|EHRA 1||EHRA 2||EHRA 3||EHRA 4||p value||Correlation coefficient (p value)|
|Total AF burden (range:3-30)||7.1±5.2||14.4±5.3||17.0±4.6||22.6±3.4||< 0.001||0.7 (<0.001)|
|Symptom severity (range 0-35)||3.6±4.7||8.8±5.8||17.7±6.6||23.8±7.4||< 0.001||0.7 (<0.001)|
|Health care utilization:|
|Cardioversion (0-7)*||0.2±0.6||0.3±0.84||0.4±1.2||0.7±0.8||0.5||0.1 (0.09)|
|Emergency room visit (0-7)*||0.2±0.4||0.7±1.1||1.7±1.8||2.8±2.0||<0.001||0.4 (<0.001)|
|Hospitalization (0-7)*||0.2±0.4||0.6±0.8||1.0±1.1||1.8±1.6||0.001||0.4 (<0.001)|
|Specialist visit (0-7)*||1.5±1.5||2.5±2.3||2.5±2.0||2.8±1.8||0.2||0.2 (0.07)|
Data are presented as mean±standard deviation. *The numbers indicate the range of scores. A correlation coefficient of > 0.6 indicate strong correlation. Increasing scores indicate increasing symptoms and severity. AFSS: Atrial Fibrillation Severity Scale EHRA:European Heart Rhythm Association class
|SAF 0||SAF 1||SAF 2||SAF 3||SAF 4||p value||Correlation coefficient (p value)|
|Total AF burden (3-30)¶||5.7±5.1||9.2±5.0||15.2±4.6||17.6±3.8||21.4±4.7||< 0.001||0.75 (<0.001)|
|Symptom severity (0-35)¶||3.3±4.0||4.2±5.2||9.9±4.2||15.2±5.0||23.6±.6.8||<0.001||0.79 (<0.001)|
|Health care utilization:|
|Emergency room visit*||0.3±0.5||0.5±1.1||0.6±1.0||1.3±1.6||2.5±1.9||<0.001||0.4 (<0.001)|
|Specialist visit*||1.7±1.5||1.8±1.8||2.8±2.6||2.2±2.1||2.7±1.7||0.47||0.18 (0.16)|
Data are presented as mean±standart deviation. A correlation coeffcient of >0.6 indicates strong correlation. ¶The numbers indicate range of scores. *The score of the items in the health care utilization subscale ranges from 0-7. Increasing scores indicate increasing symptoms. AFSS: Atrial Fibrillation Severity Scale SAF: Severity in Atrial Fibrillation class
|Internal consistency (Conbach α)|
|Total AF burden||0.85|
|Health care utilization||0.67|
AFSS: AF severity scale AF: atrial fibrillation