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Atrial Fibrillation Symptoms and Sex, Race, and Psychological Distress: A Literature Review

Gleason, Kelly, T., RN, BSN; Nazarian, Saman, MD, PhD; Dennison Himmelfarb, Cheryl, R., RN, ANP, PhD, FAHA, FPCNA, FAAN

The Journal of Cardiovascular Nursing: March/April 2018 - Volume 33 - Issue 2 - p 137–143
doi: 10.1097/JCN.0000000000000421
ARTICLES: Symptoms

Background: Atrial fibrillation (AF) symptoms are a major component of treatment decisions for patients with AF and impact quality of life and functional ability yet are poorly understood.

Objective: This review aimed to determine what is known about the prevalence of symptoms and the association of symptoms to AF characteristics, psychological distress, sex, and race.

Methods: We performed a structured review of AF symptoms as of March 2016 using PubMed, EMBASE, and CINAHL and reference searches of retrieved articles. Full-text, published, peer-reviewed, English-language articles were examined. Articles were included if they reported original research data on symptom prevalence and type among patients with AF.

Results: The 3 most common symptoms were dyspnea, palpitations, and fatigue. The results suggested that, although AF characteristics are not a significant predictor of symptoms, tachycardia, female sex, race, and psychological distress have a positive association to symptoms.

Conclusions: There is a scarcity of research examining symptoms in AF. Furthermore, the inconsistency in measurement methods and the failure to include diverse populations in AF research make it difficult to draw definitive conclusions from the current literature. Given the prevalence of AF in the United States and the impact of symptoms on quality of life and healthcare use, further research examining predictors of symptoms and interventions to alleviate symptoms is crucial.

Kelly T. Gleason, RN, BSN Doctoral Candidate, School of Nursing, Johns Hopkins University, Baltimore, Maryland.

Saman Nazarian, MD, PhD Associate Professor, School of Medicine, University of Pennsylvania, Philadelphia, and School of Medicine, Johns Hopkins University, Baltimore, Maryland.

Cheryl R. Dennison Himmelfarb, RN, ANP, PhD, FAHA, FPCNA, FAAN Professor, Schools of Nursing and Medicine, Johns Hopkins University, Baltimore, Maryland.

K.T.G. received support from predoctoral fellowship in Interdisciplinary Training in Cardiovascular Health Research, T32 NR012704, and Predoctoral Clinical Research Training Program, TL1 TR001078.

Dr Nazarian is a scientific advisor to Biosense Webster Inc and CardioSolv Inc and principal investigator for research funding to Johns Hopkins from Biosense Webster, Inc (Diamond Bar, California). All other authors have no funding or conflicts of interest to disclose.

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Correspondence Kelly T. Gleason, 525 N Wolfe St, Baltimore, MD 21205 (

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