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- Björkenheim, Anna, 1980-, et al.
(författare)
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Does zero atrial fibrillation burden after atrial fibrillation ablation mean that patients are free of symptoms?
- 2017
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Ingår i: Europace, Supplements. - : Oxford University Press. - 1099-6044 .- 1749-365X. ; 19:Duppl. 3, s. iii264-iii264
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Success of atrial fibrillation (AF) ablation is usually defined as freedom of AF, although symptomatic relief often is what the patient’s desire. After ablation the proportion of ‘silent’ AF increases and success based on symptomatic AF recurrence may be overestimated.Purpose: To investigate the symptomatology of patients who are truly free of AF after ablation.Methods: In 57 patients the symptomatology after AF ablation was assessed as perceived by the patient using a validated AF-specific symptom questionnaire (AF6) and the overall treatment effect (OTE), and as classified by the physician using the EHRA score, at baseline, 6, 12 and 24 months. The cardiac rhythm was continuously monitored by an implantable loop recorder throughout the 2-year follow-up.Results: At 6, 12 and 24 months 14 (26%), 23 (43%) and 23 (43%) patients had an AF burden 0% during the past 6 months, and 13 of them had an AF burden 0% during the entire 2 year follow-up. All patients reported ‘OTE better’ at all time-points. All patients were also classified into EHRA I at 6 months. Being completely free of AF for six months periods did not mean complete freedom of symptoms, but the median AF6 sum score was consistently low with a narrowing IQR over time, 0 (IQR 0-27), 0.5 (IQR 0-7) and 0 (IQR 0-11) at 6, 12 and 24 months. At 6 months 8/14 patients (57%) scored AF6=0, the others 6, 11, 26, 28, 30 and 46 points. At 12 months 13/23 patients (56%) scored AF6=0, the others 1,1,3,3,5,7,7,7,14 and 22 points. At 24 months 12/23 (52%) patients scored AF6=0, the others 1, 1, 2, 4, 9, 11, 17, 20, 24, 32 and 42 points. Among the AF6 items, ‘worry/anxiety due to AF’ was the most common, while ‘tiredness due to AF’ was the highest scoring item. In the patients with AF burden 0% during the entire 2-year follow-up all patients were improved in OTE and all patients were classified into EHRA class I at all times after ablation and the median AF6 sum score was 4 (IQR0-28), 0.5 (IQR 0-8) and 1 (0-5) at 6, 12 and 24 months after ablation.Conclusions: Sudden elimination of AF by ablation does not automatically eliminate all symptoms that the patients associated with AF, but all patients felt better and were classified in EHRA class I at all time-points. Less than a half of the patients at any time-point scored some symptoms, but the symptoms gradually decreased over time, especially between 6 and 12 months.
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- Lindfors, Petra, et al.
(författare)
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Stress in paid and unpaid work as related to salivary cortisol measures and subjective health complaints in women working in the public sector
- 2017
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Konferensbidrag (refereegranskat)abstract
- Purpose: From a biopsychosocial approach, moderate intensity and variation between demands of different life domains are central to health. Focusing on different aspects of work and non-work demands, we investigated how total workload (TWL) and work-family conflict (WFC) related to the stress marker cortisol and to subjective health complaints (SHC) among women working in the public sector. Overall, we hypothesized that more TWL and WFC would be reflected in poorer health.Design/methodology: Data came from a study of 250 women working within the health care sector. All provided self-reports in questionnaires on time spent on TWL and associated stress perceptions, WFC and SHC. A subsample of 68 women provided salivary samples during one workday. These samples were analyzed for cortisol and used to compute aggregate cortisol measures. Hierarchical regression analyses were performed to investigate how TWL and WFC were related to cortisol and SHC respectively.Results: TWL stress from unpaid work was associated with cortisol. Also, stress from both paid and unpaid work, and TWL-stress, were related to SHC. Importantly, number of hours spent on paid and unpaid work were not linked to any health-related measure. Instead, stress perceptions were associated with both cortisol and SHC. This underscores the importance of individuals’ experiences of demands from different life domains for different health-related measures.Limitations: We included only women.Research/practical implications: Time use data are insufficient meaning that self-reports of individual experiences are needed.Originality/value: Combining biomarker data with self-reports is an obvious strength.
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