Patient-reported outcome measures for atrial fibrillation: a systematic review and evaluation of psychometric properties of symptom severity measures.

Collection of patient-reported outcomes (PROs) is advocated for benchmarking AF care, however, concerns over the robustness of patient-reported outcome measures (PROMs) limits 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. Six 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 synthesised measurement properties and risk-of-bias of symptom severity PROMs. (PROSPERO ID: CRD42024523340). 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. ASTA 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.