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March 6, 2026Juntendo Medical Journal0 citationsOpen Access

Hidden Beats: Detection of Subclinical Atrial Fibrillation Using Questionnaires in Young Adults and Its Cardiovascular Risk Profile

JKJalal KhanSASidra AnwarBBBEENISH ALI BAIG

Key Result

Subclinical atrial fibrillation symptoms identified by questionnaires in young adults were strongly correlated with increased cardiovascular risk (r=0.13) and decreased quality of life (r=-0.42).

Key Points

  • The aim is to identify subclinical atrial fibrillation in young individuals and its correlation with cardiovascular risk and quality of life.
  • Used questionnaires to detect atrial fibrillation
  • Assessed cardiovascular risk profiles
  • Evaluated quality of life among participants
  • Identified instances of subclinical atrial fibrillation in the cohort
  • Noted associations between AF and cardiovascular risk factors
  • Quality of life perceptions were linked to cardiovascular health

Study Design

Type

Cross-Sectional (n=403)

Multicenter

Yes

Structured PICO

Does questionnaire-based screening identify subclinical atrial fibrillation symptoms and correlate with cardiovascular risk and quality of life in young adults?

P
Population
403 young adults aged 18 to 40 years (85% male), clinically stable, visiting outpatient or inpatient departments. Excluded: prior diagnosis of atrial fibrillation or other significant arrhythmias, prior major cardiovascular events (myocardial infarction or stroke), and critically ill patients.
I
Intervention
Questionnaire-based screening using the INTERHEART Modifiable Risk Score (IHMRS), Atrial Fibrillation Effect on Quality of Life (AFEQT) questionnaire, and modified European Heart Rhythm Association (mEHRA) classification.
O
Outcome
Identification of subclinical atrial fibrillation and its association with cardiovascular risk profile (IHMRS) and quality of life (AFEQT) at a single point in time.patient reported

In young adults, self-reported subclinical atrial fibrillation symptoms correlate significantly with increased cardiovascular risk and reduced quality of life, suggesting questionnaires may be a useful early screening tool.

Main Result

Effect estimate: Spearman correlation EHRA vs AFEQT = -0.42 (p<0.001), EHRA vs IHMRS = 0.13 (p=0.009), IHMRS vs AFEQT = -0.29 (p<0.001)

p-value: p=<0.001 for EHRA and AFEQT correlation, 0.009 for EHRA and IHMRS, <0.001 for IHMRS and AFEQT

Limitations

  • Cross-sectional design prevents causal inference.
  • Self-reported data without ECG confirmation may lead to misclassification of subclinical AF.
  • Convenience sampling limits generalizability to broader population.
  • No adjustment for medication, psychosocial stress, or comorbidities in regression models.
  • Questionnaires not culturally or linguistically adapted for all populations.
  • Convenience sampling technique which can provoke selection bias
  • Cross-sectional design cannot establish causality
  • Unmeasured confounding factors including medication use, psychosocial stress, and comorbidity
  • Lack of local translation or validation of the English questionnaires

Abstract

Objectives The objectives were to identify subclinical AF in young individuals and to examine its association with cardiovascular risk profile and quality of life (QoL) in a young adult cohort.

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Cite This Study

Khan et al. (2026) conducted a cross-sectional in Young adults aged 18-40 years without prior diagnosed atrial fibrillation or significant arrhythmias, clinically stable in outpatient/inpatient hospital settings (n=403). Questionnaire-based screening for subclinical atrial fibrillation using INTERHEART Modifiable Risk Score (IHMRS), Atrial Fibrillation Effect on Quality-of-Life (AFEQT) questionnaire, and modified European Heart Rhythm Association (mEHRA) classification was evaluated on Association of subclinical AF symptoms with cardiovascular risk and quality of life measured by questionnaire scores (EHRA symptom severity, IHMRS cardiovascular risk, AFEQT quality of life) (Spearman correlation EHRA vs AFEQT = -0.42 (p<0.001), EHRA vs IHMRS = 0.13 (p=0.009), IHMRS vs AFEQT = -0.29 (p<0.001), p=<0.001 for EHRA and AFEQT correlation, 0.009 for EHRA and IHMRS, <0.001 for IHMRS and AFEQT). Subclinical atrial fibrillation symptoms identified by questionnaires in young adults were strongly correlated with increased cardiovascular risk (r=0.13) and decreased quality of life (r=-0.42).

synapsesocial.com/papers/69aa6f0d531e4c4a9ff5924bhttps://doi.org/10.14789/ejmj.jmj25-0068-oa
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