CBT improves life quality of patients with symptomatic paroxysmal AF

Online cognitive behavioural therapy (CBT) helps improve quality of life (QoL) and reduce healthcare use in patients with symptomatic paroxysmal atrial fibrillation (AF), suggests a study.

In total, 127 patients with symptomatic paroxysmal AF were randomized to receive either AF-CBT (n=65) or standardized AF education (n=62). Online CBT was guided by a therapist and lasted for 10 weeks. The main components were exposure to cardiac-related symptoms and a decrease in AF-related avoidance behaviour. The authors assessed the patients at baseline, post-treatment, and at the 3-month follow-up.

AF-specific QoL, assessed using the Atrial Fibrillation Effect on Quality of Life summary score (range, 0‒100) at the 3-month follow-up, was the primary endpoint. Secondary endpoints were AF-specific healthcare use and AF burden assessed by 5-day continuous electrocardiogram recording. The AF-CBT group was followed for 1 year.

AF-CBT resulted in significant improvements in AF-specific QoL (15.0 points, 95 percent confidence interval [CI], 10.1‒19.8; p<0.001) and in a 56-percent (95 percent CI, 22‒90; p=0.025) reduction in healthcare consumption. The AF burden, however, did not change. Notably, results on self-assessed outcomes persisted for 12 months after treatment.

“If these results are replicated, online CBT may constitute an important addition to AF management,” the authors said.

AF is usually accompanied by troubling symptoms, which may impair QoL and increase healthcare use, according to the authors, adding that symptom preoccupation (ie, fear of cardiac-related symptoms and avoidance behaviour) may lead to disability in AF but is not addressed by current interventions.