Depression in patients with atrial fibrillation - prevalence, association with health-related quality of life and handgrip strength - a cross-sectional study.

BACKGROUND: A reciprocal association of atrial fibrillation (AF) and depression has been proposed, but depression is often underdiagnosed in cardiology. We assessed the prevalence of suspected depression in a consecutive cohort of patients with AF examined its association with disease-related quality of life (QoL) and handgrip strength. METHODS: In this single-center cross-sectional study of a prospectively recruited consecutive cohort of patients with documented AF, 100 patients completed the AF Effect On Quality-Of-Life Questionnaire (AFEQT) questionnaire. The Patient Health Questionnaire (PHQ-9) and Montgomery-Asberg Depression Rating Scale (MADRS) was used to scale suspected depression severity. Handgrip strength was measured using a hydraulic handgrip dynamometer. A multivariable linear regression analysis for reduced handgrip was performed and associations between AFEQT, PHQ-9 and MADRS were assessed via Spearman correlation analysis. RESULTS: Depressive symptoms were found in 53% of patients on at least one screening tool, and 30% met criteria in both PHQ-9 and MADRS. Most cases (79.3%) represented new suspected diagnoses. Patients with suspected depression had lower AFEQT scores (49.1 points [38.5-65.7]) compared to those without (71.3 points [59.3-88.0], p < 0.001). The AFEQT overall score moderately correlated with PHQ-9 (r = -0.534, p < 0.001) and MADRS (r = -0.410, p < 0.001). Handgrip strength did not differ between groups but was independently associated with older age (B = -0.47, p < 0.001), female sex (B = -12.5, p < 0.001), and higher MADRS scores (B = -0.40, p = 0.012), R = 0.773. Among patients with suspected depression, 28% indicated willingness to use a mental health app, with higher acceptance in those <70 years. CONCLUSION: Previously unrecognized depressive symptoms are highly prevalent and often newly detected in patients with AF, with a significant negative association with disease-specific QoL. Routine screening with validated tools should be integrated into cardiology practice to enable timely diagnosis and comprehensive psycho-cardiological management.