Presentations of AFib
AFib can present in various ways
While understanding the impact of AFib and related stroke risk is crucial, it is equally important to examine the different presentations and classifications of AFib.
Patients experiencing AFib can be either symptomatic or asymptomatic, which can make diagnosis challenging. Patients with asymptomatic (or silent) AFib do not present with symptoms but do remain at-risk for stroke.6
AFib is characterized by duration of episodes, which often increase in frequency and duration over time. To understand AFib, it’s important to understand the classifications. Classifications of AFib are defined as follows6:
- Paroxysmal: AFib that terminates spontaneously or within 7 days of onset; episodes may occur with variable frequency
- Persistent: Continuous AFib sustained for more than 7 days
- Long-standing: Continuous for more than 12 months
- Permanent: Terminology used when both patient and clinician make a decision to discontinue intervention to maintain or restore sinus rhythm
Examining the presentations of AFib reported in a large-scale national study
Using data from ORBIT-AF, a national observational community-based outpatient registry of 10,087 patients with AFib in the US conducted between June 2010 and August 2011, symptom severity was evaluated at baseline using the physician-assessed EHRA classification system.7
- The EHRA classification system is used to assess and quantify symptoms related to AFib. The EHRA classification is based on the impact of symptoms on daily activity during presumed episodes of AFib
- EHRA proposed scoring system for AFib-related symptoms: 1=asymptomatic, 2=mild, 3=severe, 4=disabling
Within the study, participants fell into 2 categories, asymptomatic and symptomatic based on the EHRA classification.7
Within the study, participants fell into 2 categories, asymptomatic and symptomatic based on the EHRA classification.7
0%
of patients were
asymptomatic
0%
of patients were
symptomatic
- Individual patient-reported symptoms were also assessed, including palpitations, syncope or fainting, dyspnea on exertion, exercise intolerance, lightheadedness or dizziness, dyspnea at rest, fatigue, and chest tightness or discomfort7
- Among patients identified by physicians as asymptomatic using the EHRA score, the vast majority reported no individual symptoms, but 11% reported at least one symptom, with palpitations being the most common (6%)7
EHRA=European Heart Rhythm Association; ORBIT-AF=Outcomes Registry for Better Informed Treatment of Atrial Fibrillation.
Classifications of AFib observed in the ORBIT-AF Study
In the ORBIT-AF study, below are the classifications of AFib, as reported in baseline characteristics of the 10,087 patients, inclusive of both symptomatic and asymptomatic groups.7
(N=1695)
(N=5096)
(N=2819)
(N=477)
Paroxysmal (N=5096)
Persistent (N=1695)
Long-Standing Persistent (N=2819)
New onset (N=477)
Study objective: To assess the symptom severity and quality of life of patients suffering from AFib using the EHRA classification system and AFEQT questionnaire.7
Study limitations: Although the large, community-based cohort included in this study was broadly representative of patients with AFib in the United States, the study evaluated patients who were undergoing treatment for AFib and the results may not be generalizable to a disadvantaged or untreated population.7 The study controlled for a large number of covariates, however a potential limitation of this study may be the presence of residual or unmeasured confounding in the analyses, evaluating the association between AFib symptoms and outcomes.7
AFEQT=AFib Effect on QualiTy of life.