Interpreting Changes in Quality of Life in Atrial Fibrillation
Interpreting Changes in Quality of Life in Atrial Fibrillation
Occurrence of atrial fibrillation
Are you currently in atrial fibrillation? □ Yes □ No.
If No, when was the last time you were aware of having had an episode of atrial fibrillation?
(Please check one answer which best describes your situation)
_earlier today
_within the past week
_within the past month
_1 month to 1 year ago
_>1 year ago
_I was never aware of having atrial fibrillation
The following questions refer to how atrial fibrillation affects your quality of life.
On a scale of 1 to 7, over the past 4 weeks, as a result of your atrial fibrillation, how much were you bothered by:
(Please circle one number which best describes your situation)
(Enlarge Image)
On a scale of 1 to 7, over the past 4 weeks, have you been limited by your atrial fibrillation in your:
(Please circle one number which best describes your situation)
(Enlarge Image)
On a scale of 1 to 7, over the past 4 weeks, as a result of your atrial fibrillation, how much difficulty have you had in:
(Please circle one number which best describes your situation)
(Enlarge Image)
On a scale of 1 to 7, over the past 4 weeks as a result of your atrial fibrillation, how much did the feelings below bother you?
(Please circle one number which best describes your situation)
(Enlarge Image)
On a scale of 1 to 7, over the past 4 weeks, as a result of your atrial fibrillation treatment, how much were you bothered by:
(Please circle one number which best describes your situation)
(Enlarge Image)
On a scale of 1 to 7, overall, how satisfied are you at the present time with:
(Please circle one number which best describes your situation)
(Enlarge Image)
Appendix A. AFEQT Questionnaire
Section 1.
Occurrence of atrial fibrillation
Are you currently in atrial fibrillation? □ Yes □ No.
If No, when was the last time you were aware of having had an episode of atrial fibrillation?
(Please check one answer which best describes your situation)
_earlier today
_within the past week
_within the past month
_1 month to 1 year ago
_>1 year ago
_I was never aware of having atrial fibrillation
Section 2.
The following questions refer to how atrial fibrillation affects your quality of life.
On a scale of 1 to 7, over the past 4 weeks, as a result of your atrial fibrillation, how much were you bothered by:
(Please circle one number which best describes your situation)
(Enlarge Image)
On a scale of 1 to 7, over the past 4 weeks, have you been limited by your atrial fibrillation in your:
(Please circle one number which best describes your situation)
(Enlarge Image)
On a scale of 1 to 7, over the past 4 weeks, as a result of your atrial fibrillation, how much difficulty have you had in:
(Please circle one number which best describes your situation)
(Enlarge Image)
On a scale of 1 to 7, over the past 4 weeks as a result of your atrial fibrillation, how much did the feelings below bother you?
(Please circle one number which best describes your situation)
(Enlarge Image)
On a scale of 1 to 7, over the past 4 weeks, as a result of your atrial fibrillation treatment, how much were you bothered by:
(Please circle one number which best describes your situation)
(Enlarge Image)
On a scale of 1 to 7, overall, how satisfied are you at the present time with:
(Please circle one number which best describes your situation)
(Enlarge Image)
