Validity and reliability studies of the Indonesian version of Atrial Fibrillation Severity Scale (AFSS)

Background: In the atrial fibrillation (AF) population, worsened quality of life (QOL) has been reported even before complications occur. Symptom-based questionnaires can be used to evaluate AF treatment. The Atrial Fibrillation Severity Scale (AFSS) was first developed in Canada in English, which is not the main language in Indonesia. This study aims to test the reliability and validity of the Indonesian version of the Atrial Fibrillation Severity Scale (AFSS). Methods: Translation of the AFSS from English to Indonesian was done using forward and backward translation. The final version was then validated with the Short Form-36 (SF-36) questionnaire, and a test-retest reliability study was done in a 7-14-day interval. Results: An Indonesian version of AFSS was achieved and deemed acceptable by a panel of researchers. This version is reliable and valid, with Cronbach’s α of 0.819, Intraclass Correlation Coefficient (ICC) ranging from 0.803 to 0.975, and total score correlation ranging from 0.333 to 0.895. Pearson’s analysis of AFSS and SF-36 revealed that the total AF burden domain was poorly correlated with role limitations due to emotional problems (r:0.427; p < 0.01) and pain (r:0.495; p < 0.01). The symptom severity domain was poorly correlated with physical functioning (r:-0.335; p < 0.01), role limitations due to emotional problems (r:0.499; p < 0.01), pain (r:0.458; p < 0.01), and total SF-36 score (r:-0.361; p < 0.01). Total AFSS score was moderately correlated with role limitations due to emotional problems (r:0.516; p < 0.01) and pain (r:0.538; p < 0.01). The total AFSS score was poorly correlated with the European Heart Rhythm Association (EHRA) score (r:0.315; p < 0.01). Conclusion: The Indonesian version of AFSS has good internal and external validity with good reliability.