SynthesisEuropace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology2026
Patient-reported outcome measures for atrial fibrillation: a systematic review and evaluation of psychometric properties of symptom severity measures.
Synthesis in Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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5 authors.
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Abstract
aimsCollection of patient-reported outcomes (PROs) is advocated for benchmarking atrial fibrillation (AF) care; however, concerns over the robustness of patient-reported outcome measures (PROMs) limit their use in clinical practice. This systematic review identified PROMs used to evaluate health-related quality of life, physical, emotional, and cognitive function, symptom severity, exercise tolerance, and ability to work and appraised the measurement properties of symptom severity PROMs. METHODS AND
resultsSix bibliographic databases were searched from inception until 11 January 2025. Full-text publications in all languages investigating ≥1 measurement property of PROMs in AF patients aged ≥18 years were eligible. The Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) recommendations appraised and synthesized measurement properties and risk of bias of symptom severity PROMs (PROSPERO ID: CRD42024523340). A total of 709 eligible publications identified 101 PROMs; six symptom severity PROMs (AFSymp, AFS/B, AFSS, ASTA, AF6, and SCL) underwent psychometric property evaluation. ASTA, AFSymp, and SCL indicated evidence of sufficient content validity and at least low-quality evidence for sufficient internal consistency. ASTA was the most validated PROM and exhibited the greatest level of certainty in evidence quality across assessed psychometric properties. COSMIN assessments revealed critical gaps in responsiveness and cross-cultural validity.
conclusionASTA emerged as the most robust symptom severity PROM. Further validation of PROMs identified for other PROs by COSMIN guidelines is recommended prior to their routine integration in AF care, and future studies should address responsiveness, interpretability, feasibility, and cross-cultural validity to ensure PROMs reliably reflect patients' experiences and detect meaningful clinical changes across diverse populations.
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