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TOPLINE:

Physician underestimation of the symptom burden in patients with atrial fibrillation (AF) is common and is associated with less frequent treatment escalation and smaller improvements in health status over 1 year. 

METHODOLOGY:

• In a prospective cohort study, conducted in two outpatient practices in Tokyo, Japan, 330 patients newly diagnosed or referred with AF completed the Atrial Fibrillation Effect on Quality-of-Life (AFEQT) questionnaire. 
• Blinded to patients' responses, treating physicians answered a three-item questionnaire quantifying each patient's AFEQT domain with a single item. 

TAKEAWAY:

• Results showed that physicians correctly estimated health status in just 34% of patients. Health status was underestimated in 13% of patients and overestimated in 53%. 
• Treatment escalation occurred in 64% of patients whose health status was correctly estimated, 48% of those whose health status was underestimated, and 66% of patients whose health status was overestimated. 
• After multivariable adjustment, underestimation of health status was independently associated with less treatment escalation (adjusted odds ratio, 0.43) and less frequent AFEQT overall summary score improvement at 1 year (underestimated vs correctly and overestimated health status, 2.5 vs 8.4 points). 

IN PRACTICE:

These data highlight an important gap in practice and suggest that standardizing assessments of patients' health status using validated disease-specific questionnaires has the potential to improve decisions for treatment escalation, and health status gains over time, the study authors concluded. In an accompanying editorial, Benjamin A. Steinberg, MD, University of Utah Health Sciences Center, Salt Lake City, noted that when symptom status and health-related quality of life drives treatment decisions, particularly regarding invasive procedures or higher-risk medications, relying on clinician impression of symptoms is suboptimal and may lead to the loss of an opportunity to improve clinical outcomes. Shared decision-making tools improve communication between patients and physicians on symptoms and treatment priorities, and to improve care of all patients with AF, it is time to consistently incorporate these tools in the clinic, Steinberg added.

SOURCE:

The study, led by Nobuhiro Ikemura, MD, Keio University School of Medicine, Tokyo, Japan, was published online in JAMA Network Open on February 23. 

LIMITATIONS

The use of different instruments in quantifying health status may have accounted for some of the discordance observed. Unmeasured confounding factors, such as depression, frailty, and economic status, may have influenced physicians' estimations of patients' health status and treatment escalation. Further research with larger sample sizes is necessary to thoroughly identify and understand systematic biases associated with discordant perceptions between patients with AF and physicians regarding health status.

DISCLOSURES:

This study was funded by the BMS/Pfizer Japan Thrombosis Investigator Initiated Research Program.