Atrial fibrillation through the patient's eyes.

It is of use because it gives us a simple and reliable tool to use at the bedside to understand patients’ experiences with atrial fibrillation. We have scales that assess patient’s overall health status (so-called generic questionnaires), the most widely used of which is the SF-36 questionnaire. The SF-36 has been used previously to assess health status in a number of studies of atrial fibrillation.2 Its length, however, limits its use in everyday clinical practice. A shorter version (the SF-12) is available, but it is not clear if this questionnaire is able to separate the impact of atrial fibrillation from the burden of comorbidity that is the lot of the typical patient. We also have questionnaires specific for atrial fibrillation.3–5 Although they might be able to dissect the impact of atrial fibrillation from that of comorbidity, they have not been widely used and are too long for bedside use. Scales useful at the bedside have characteristics in common. They combine data from a large enough number of variables to provide adequate discrimination yet from a small enough number of variables to allow commitment to memory—usually 3 to 5. The data are typically available from the history, physical examination, and/or routine laboratory testing. If calculation is needed, it is by simple sum. The prototype for a universally useful scale is the Apgar score for assessing the newborn infant.6,7 It assigns values of 0, 1, or 2 to levels of 5 variables (heart rate, respiration, muscle tone, skin color, and response to stimuli) and sums them to give a score from 0 to 10. Other widely used scales include the New York Heart Association classification of heart failure severity, well known to cardiologists, in which a score of 1 to 4 is assigned on the basis of the history. The CCS-SAF scale has these properties of a clinimetrically useful tool. Based on experience with a disease-specific questionnaire for atrial fibrillation,3 an expert panel developed a 3-step process to classify patients’ experiences with atrial fibrillation into 1 of 5 levels.8 First, the presence of atrial fibrillation symptoms (palpitations, dyspnea, dizziness, chest pain, weakness) is obtained. Next, an association between symptoms and an episode or episodes of atrial fibrillation is sought. Finally, the impact of the symptoms on patients’ functioning is established, ranging from asymptomatic (SAF 0) through minimal (SAF 1), minor (SAF 2), and moderate (SAF 3), to severe (SAF 4). The “Symptoms, Association, Functioning” assessment scheme corresponds nicely to the scale’s “SAF” acronym.