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Clinical Trial Details — Status: Completed

Administrative data

NCT number NCT04962932
Other study ID # AF RCT 2
Secondary ID
Status Completed
Phase N/A
First received
Last updated
Start date August 13, 2021
Est. completion date October 5, 2023

Study information

Verified date October 2023
Source Karolinska Institutet
Contact n/a
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

The aim of this study is to evaluate if internet- delivered cognitive behavior therapy (CBT), based on exposure principles and behavioral activation, improves QoL and symptom burden in patients with symptomatic atrial fibrillation (AF), controlling for expectancy of improvement and attention from a caregiver, using an active control group (stress management). The study will include 260 patients with symptomatic AF despite optimal medical treatment in accordance with current guidelines.


Description:

Atrial fibrillation (AF) is the most common cardiac arrhythmia (irregular heartbeat) affecting 3% of the population. AF is associated with poor quality of life (QoL) and large costs for society. In a considerable proportion of patients, AF symptoms (e.g., palpitations, fatigue, and chest pain) are not alleviated by current medical or interventional treatments. Psychological factors can worsen AF symptoms, and anxiety and depression are common among AF patients. Symptom preoccupation and avoidance of social and physical activities are likely to play important roles in the development of anxiety, depression, disability and healthcare utilization. The aim is to evaluate if CBT, based on behavioral activation and exposure principles, improves wellbeing and QoL in symptomatic AF patients controlling for expectancy of improvement and attention from a caregiver using an active control group receiving stress management treatment (SMT). Method: A randomized controlled trial. Participants are randomized to internet- delivered exposure-based CBT (N=130) or to SMT (N=130). Participants in both groups receive weekly therapist support through online written communication. The internet-delivered SMT-treatment includes life-style advice (e.g., exercise, sleep advice), relaxation and problem-solving skills to reduce stress. Both treatments lasts 10 weeks and are comparable regarding number of treatment modules, treatment burden and attention from the treating psychologist.


Recruitment information / eligibility

Status Completed
Enrollment 206
Est. completion date October 5, 2023
Est. primary completion date March 31, 2023
Accepts healthy volunteers No
Gender All
Age group 18 Years to 75 Years
Eligibility Inclusion Criteria: - Paroxysmal AF = once per month that causes moderate to severe symptoms and leads to significant distress or interferes with daily life (i.e. EHRA class = IIb); - Scoring = 20 on the Cardiac Anxiety Questionnaire at screening; - Age 18-75 years; - On optimal medical treatment; - Able to read and write in Swedish. Exclusion Criteria: - Heart failure with severe systolic dysfunction (ejection fraction = 35%); - Significant valvular disease; - Planned ablation for AF or ablation within 3 months before assessment; - Other severe medical illness; - Any medical restriction to physical exercise; - Severe psychiatric disorder, severe depression, or risk of suicide; - Alcohol dependency; - Previous participation in any AF-CBT study conducted by the research group.

Study Design


Related Conditions & MeSH terms


Intervention

Behavioral:
Internet-deliviered exposure-based CBT
The intervention lasts for 10 weeks and include: Education, Interoceptive exposure, exposure in-vivo, combining in-vivo exposure with interoceptive exposure, behavioral activation and relapse prevention. Include the guidance of a minimum weekly contact with a CBT psychologist.
Internet-delivered stress management treatment
The intervention last for 10 weeks and include: Internet-SMT include life-style advice (e.g., exercise, sleep advice), relaxation and problem-solving skills to reduce stress. Patients are offered regular online contact with a psychologist with the same frequency and intensity as in the CBT arm.

Locations

Country Name City State
Sweden Karolinska universitetssjukhuset Solna Solna

Sponsors (2)

Lead Sponsor Collaborator
Karolinska Institutet Karolinska University Hospital

Country where clinical trial is conducted

Sweden, 

Outcome

Type Measure Description Time frame Safety issue
Other Psychosocial stressors and changes in physical health Participants are asked about their self-perceived health and if they have experienced any stressful event that they believe have affected their health (e.g severe disease, death of close relative, divorce) 10 weeks from baseline
Other Psychosocial stressors and changes in physical health Participants are asked about their self-perceived health and if they have experienced any stressful event that they believe have affected their health (e.g severe disease, death of close relative, divorce) 9 months from baseline
Other Background data Demographics, list of medications, co-morbidity, smoking history and alcohol consumption Baseline
Other Treatment Credibility Scale Measures treatment credibility 2-4 weeks from baseline
Other Working Alliance Inventory Measures therapeutic alliance with the psychologist 2-4 weeks from baseline
Other Changes in medication Participants are asked if they have made any changes in medication 10 weeks from baseline
Other Changes in medication Participants are asked if they have made any changes in medication 9 months from baseline
Primary Atrial Fibrillation Effect on Quality-of-Life modified for weekly assessment The AFEQT is an atrial fibrillation-specific measure that taps into the QoL-domains: symptoms, daily activities, treatment concern, and treatment satisfaction. Total score ranges from 0 (severe symptoms and disability) to 100 (no symptoms and disability). Change over 11 measurement points measured from baseline and weekly for 10 weeks during treatment [PRIMARY ENDPOINT]
Primary Atrial Fibrillation Effect on Quality-of-Life modified for weekly assessment The AFEQT is an atrial fibrillation-specific measure that taps into the QoL-domains: symptoms, daily activities, treatment concern, and treatment satisfaction. Total score ranges from 0 (severe symptoms and disability) to 100 (no symptoms and disability). From baseline to 9 months
Secondary Cardiac Anxiety Questionnaire (CAQ) Measure of cardiac anxiety, fear, avoidance and attention. The score ranges between 0 and 72, with a greater score indicating elevated cardiac anxiety. From baseline to 10 weeks
Secondary Cardiac Anxiety Questionnaire (CAQ) Measure of cardiac anxiety, fear, avoidance and attention. The score ranges between 0 and 72, with a greater score indicating elevated cardiac anxiety. From baseline to 9 months
Secondary AF-avoidance behavior questionnaire Form measuring AF-specific avoidance- and control behaviors, developed by the research group From baseline to 10 weeks
Secondary AF-avoidance behavior questionnaire Form measuring AF-specific avoidance- and control behaviors, developed by the research group From baseline to 9 months
Secondary AF-avoidance behavior questionnaire modified for weekly assessment 4 items from the AF-avoidance behavior questionnaire Change over 11 measurement points measured from baseline and weekly for 10 weeks during treatment
Secondary Short Form Health Survey (SF-12) General quality of life, with a score ranging from 0 to 100. A higher score indicating a better quality of life From baseline to 10 weeks
Secondary Short Form Health Survey (SF-12) General quality of life, with a score ranging from 0 to 100. A higher score indicating a better quality of life From baseline to 9 months
Secondary Atrial Fibrillation Severity Scale (4 items) 4 items from the Atrial Fibrillation Severity Scale, measuring health care seeking From baseline to 10 weeks
Secondary Atrial Fibrillation Severity Scale (4 items) 4 items from the Atrial Fibrillation Severity Scale, measuring health care seeking From baseline to 9 months
Secondary The Godin-Shepard Leisure-Time Physical Activity Questionnaire Level of physical activity. The participant rate numbers of time per week that they engage in physical activity. The numb ers are the categorized in to low, moderate, and high levels of physical activity. From baseline to 10 weeks
Secondary The Godin-Shepard Leisure-Time Physical Activity Questionnaire Level of physical activity. The participant rate numbers of time per week that they engage in physical activity. The numb ers are the categorized in to low, moderate, and high levels of physical activity. From baseline to 9 months
Secondary Body Sensation Questionnaire Fear of bodily symptoms, score ranging from 0 to 72 . Higher scores indicate more fear of body sensations. From baseline to 10 weeks
Secondary Body Sensation Questionnaire Fear of bodily symptoms, score ranging from 0 to 72 . Higher scores indicate more fear of body sensations. From baseline to 9 months
Secondary Patient Health Questionnaire-2 Short form measuring depression, score ranging 0 to 6 with a higher score indicating higher level of depression. From baseline to 10 weeks
Secondary Patient Health Questionnaire-2 Short form measuring depression, score ranging 0 to 6 ,with a higher score indicating higher level of depression. From baseline to 9 months
Secondary Perceived Stress Scale (4 items version) Measures perceived stress, score ranging from 0-16, with a higher score indicating higher level of perceived stress From baseline to 10 weeks
Secondary Perceived Stress Scale (4 items version) Measures perceived stress, score ranging from 0-16, with a higher score indicating higher level of perceived stress From baseline to 9 months
Secondary Generalized Anxiety Disorder-2 (GAD-2) General anxiety, score ranging from 0-6, with a higher score indicating more anxiety and worry. From baseline to 10 weeks
Secondary Generalized Anxiety Disorder-2 General anxiety, score ranging from 0-6, with a higher score indicating more anxiety and worry. From baseline to 9 months
Secondary Insomnia Severity Index (5 items) Measure of insomnia, score ranging from 0-20, with a higher score indicating more severe insomnia From baseline to 10 weeks
Secondary Insomnia Severity Index (5 items) Measure of insomnia, score ranging from 0-20, with a higher score indicating more severe insomnia From Baseline to 9 months
Secondary Perceived Competence Scale Perception of AF-specific knowledge and competence, score ranging from 0- 50 with higher score indicating higher perceived competence From baseline to 10 weeks
Secondary Perceived Competence Scale Perception of AF-specific knowledge and competence, score ranging from 0- 50 with higher score indicating higher perceived competence From baseline to 9 months
Secondary Client Satisfaction Questionnaire Treatment satisfaction, score ranging from 0-24, with a higher score indicating higher satisfaction with treatment. 10 weeks from baseline
Secondary Adverse events Potential adverse reactions to the treatment. Participants will be asked to report and rate the short- and long term discomfort of the adverse event on a scale from 0 ('did not affect me at all') and 3 ('affected me very negatively'). 10 weeks from baseline
Secondary Adverse events Potential adverse reactions to the treatment. Participants will be asked to report and rate the short- and long term discomfort of the adverse event on a scale from 0 ('did not affect me at all') and 3 ('affected me very negatively'). 9 months from baseline
Secondary Symptoms Checklist Severity and Frequency Scale (SCL) AF-related symptoms From baseline to 10 weeks
Secondary Symptoms Checklist Severity and Frequency Scale (SCL) AF-related symptoms measured in two sub scales A) frequency: score ranging from 0-48, with higher score indicating higher frequency of symptoms, B) severity of experienced symptom: score ranging from 0- 48, with a higher score indicating more severe symptoms From baseline to 9 months
Secondary AFFS/SCL-4 4 items derived from the Symptoms Checklist (SCL) and the Atrial Fibrillation Severity Scale (AFSS) measuring disabling cardiac symptoms not specified in AFEQT Weekly from baseline to 10 weeks
Secondary AFFS/SCL-4 4 items derived from the Symptoms Checklist (SCL) and the Atrial Fibrillation Severity Scale (AFSS) measuring disabling cardiac symptoms not specified in AFEQT From baseline to 9 months
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