April 1, 2009Circulation Arrhythmia and Electrophysiology179 citationsOpen Access
View Full PaperValidation of a New Simple Scale to Measure Symptoms in Atrial Fibrillation
Structured PICO
Does the CCS-SAF scale accurately correlate with validated patient-reported quality of life and symptom severity measures in patients with atrial fibrillation?
P
Population
484 patients with documented atrial fibrillation (62% paroxysmal and 38% persistent/permanent), mean age 62.2 years, 67% men.
I
Intervention
Assessment using the Canadian Cardiovascular Society Severity in Atrial Fibrillation (CCS-SAF) scale
C
Comparator
Validated quality-of-life questionnaires (SF-36 generic scale and disease-specific AFSS)
O
Outcome
Correlation between the SAF class and measures of symptom severity, physical and emotional components of quality of life, general well-being, and health care consumptionpatient reported
The CCS-SAF scale is a simple, valid bedside tool that closely approximates patient-reported quality of life and symptom severity in atrial fibrillation.
Abstract
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.