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    Atrial Fibrillation Impact Questionnaire (AFImpact): Validity and reliability of the Turkish version
    (Aves, 2021) Zeren, Melih; Demir, Rengin; Karcı, Makbule; Yiğit, Zerrin; Uzunhasan, Işıl; Gürses, Hülya Nilgün
    Objective: Guidelines recommend measuring and addressing health-related quality of life in the management of atrial fibrillation (AF); however, a disease-specific questionnaire is lacking for the Turkish language. Our aim was to translate and adapt the Atrial Fibrillation Impact Questionnaire (AFImpact) into Turkish and to explore its psychometric properties. Methods: This cross-sectional study was conducted in two phases, including the translation and cultural adaptation of AFImpact into Turkish language and the analysis of psychometric properties of the translated questionnaire. 98 patients diagnosed with AF were evaluated using the Turkish version of AFImpact, Short Form-36 (SF-36) and Pittsburg Sleep Quality Index (PSQI). Reliability, validity, and factor structure of the Turkish version of AFImpact was explored. Results: Cronbach's alpha coefficients for vitality, emotional distress, and sleep domains of AFImpact was 0.956, 0.955, and 0.819, respectively, indicating good-to-excellent internal consistency. No significant difference was detected between the initial and retest scores, and intraclass correlation coefficients of each domain varied between 0.991 and 0.996, indicating excellent test-retest reliability. Each domain of AFImpact highly correlated with similar domains of SF-36 and PSQI, having correlation coefficients between -0.484 and -0.699. AFImpact was able to discriminate between the patients in different functional classes, confirming know-groups validity. Factor analysis revealed AFImpact had the same factorial structure as the original questionnaire. Conclusion: The Turkish version of AFImpact is a valid and reliable questionnaire for evaluating health-related quality of life in patients with AF.
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    Cut-off values of 6-min walk test and sit-to-stand test for determining symptom burden in atrial fibrillation
    (Springer London Ltd, 2022) Zeren, Melih; Karcı, Makbule; Demir, Rengin; Gürses, Hülya Nilgün; Oktay, Veysel; Uzunhasan, Işıl; Yiğit, Zerrin
    Background Since symptomatology is a major predictor of quality of life and an endpoint for the management of atrial fibrillation (AF), practical approaches for objectively interpreting symptom burden and functional impairment are needed. Aims We aimed to provide cut-off values for two frequently used field tests to be able to objectively interpret symptom burden in atrial fibrillation. Methods One hundred twenty-five patients with AF were evaluated with European Heart Rhythm Association (EHRA) score, 6-min walk test (6MWT), 30 s sit-to-stand test (30 s-STST), Short-Form 36 (SF-36), International Physical Activity Questionnaire-Short Form (IPAQ-SF), and spirometry. Patients with EHRA 1 were classified as asymptomatic, and those with EHRA 2-4 as symptomatic. Cut-off values of 6MWT and 30 s-STST for discriminating between these patients were calculated. Results The optimal cut-off value was 450 m for 6MWT (sensitivity: 0.71; specificity of 0.79) and 11 repetitions for 30 s-STST (sensitivity 0.77; specificity of 0.70). Area under ROC curve was 0.75 for both tests (p < 0.001). Discriminative properties of the two tests were similar, and they were significantly correlated (r = 0.58; p < 0.001). Subgroup analysis revealed patients below cut-off values also had worse outcomes in SF-36, IPAQ-SF, and spirometry. Conclusions In patients with AF, walking < 450 m in 6MWT or performing < 11 repetitions in 30 s-STST indicates increased symptom burden, as well as impaired exercise capacity, quality of life, physical activity participation, and pulmonary function. These cut-off values may help identifying patients who may require adjustments in their routine treatment or who may benefit from additional rehabilitative approaches.