Illness perceptions, affective response, and health-related quality of life in patients with atrial fibrillation Deirdre A. Lane a, ⁎ ,1 , Caroline M. Langman b,1 , Gregory Y.H. Lip a , Arie Nouwen b a University Department of Medicine, City Hospital NHS Trust, Birmingham, UK b School of Psychology, University of Birmingham, Edgbaston, Birmingham, UK Received 17 October 2007; received in revised form 6 October 2008; accepted 14 October 2008 Abstract Objective: The purpose of this study was to determine how health-related quality of life (HRQoL), depression, and anxiety change over the first 12 months following diagnosis of atrial fibrillation (AF). In addition, we also aimed to investigate whether illness perceptions and beliefs about medication at the time of diagnosis are associated with HRQoL and affective response over time. Methods: Seventy patients [mean (S.D.) age of 71.4 (9.1) years; 45 (64.3%) were men] with ‘lone’ AF completed the Beck Depression Inventory Short Form (BDI-SF-13), State–Trait Anxiety Inventory (STAI), Perceived Stress Scale (PSS), Short- Form Medical Outcomes Survey (SF-36), Illness Perception Questionnaire, and Beliefs about Medication Questionnaire at baseline and the BDI-SF-13, STAI, PSS, and SF-36 at 6 and 12 months after diagnosis of AF. Results: Lone AF patients reported few depressive symptoms, while anxiety symptoms predominated, with a prevalence of elevated state anxiety (STAI- S ≥40) of 38.5%, 30.9%, and 35.7% at baseline and at 6 and 12 months, respectively. There were no significant differences in the levels of depression and mean levels of state and trait anxiety, perceived stress, and HRQoL (except for an increase in energy and decline in general health perception) over time. Baseline state and trait anxiety afforded the best prediction of state anxiety trajectory over 12 months (42% and 5%, respectively). The number of symptoms patients perceived as attributable to AF and specific concerns relating to their medication, at baseline, were independent predictors of physical health trajectories over 12 months after adjustment for age, gender, and AF type (P=.01) and together accounted for 15% of the variance in the slope. Conclusion: Anxiety appears to be the main affective response to diagnosis of AF in a cohort of patients without other associated comorbidities. Patients' perceptions of their symptoms and concerns about the necessity of medication at diagnosis should be specifically addressed as part of their medical management. © 2009 Elsevier Inc. All rights reserved. Keywords: Atrial fibrillation; Depression; Anxiety; Quality of life; Illness perceptions Introduction Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and is more prevalent with increasing age, affecting 5% of people aged ≥65 years and 1 in 10 people aged ≥80 years [1]. Data from the Framingham study [2] suggest that ‘lone’ AF, in an otherwise structurally normal heart, accounts for approximately 15% of all cases in the community. Many people with AF are asymptomatic while others may experience palpitations, dizziness, exercise intolerance, fatigue, chest pain, and breathlessness and may have significant impairments in their daily lives as a result of their AF. The impact of AF on health-related quality of life (HRQoL) has received much attention over the last 15 years. A recent systematic review of HRQoL in AF Journal of Psychosomatic Research 66 (2009) 203 – 210 ⁎ Corresponding author. University Department of Medicine, City Hospital, B18 7QH Birmingham, UK. Tel.: +44 0121 507 5080; fax: +44 0121 507 5907. E-mail address: deirdre.lane@swbh.nhs.uk (D.A. Lane). 1 Joint first authors. 0022-3999/08/$ – see front matter © 2009 Elsevier Inc. All rights reserved. doi:10.1016/j.jpsychores.2008.10.007