Elsevier

American Heart Journal

Volume 182, December 2016, Pages 135-143
American Heart Journal

Clinical Investigation
Patient factors associated with quality of life in atrial fibrillation

https://doi.org/10.1016/j.ahj.2016.08.003Get rights and content

Background

As treatment options for atrial fibrillation (AF) increase, more attention is focused on patients' experiences and quality of life (QoL). However, little is known about the factors associated with these outcomes.

Methods

The Atrial Fibrillation Effect on QualiTy-of-life (AFEQT) is a disease-specific QoL tool for AF, with domain and summary scores ranging from 0 (the worst QoL) to 100. Using multivariable linear regression, we evaluated factors associated with baseline AFEQT Summary and Subscale Scores in ORBIT AF, a large, community-based AF registry. Independent associations were reported as coefficient estimates in scores and 95% confidence intervals (CI).

Results

Overall, AFEQT was assessed in 2007 AF outpatients from 99 sites. Median age (IQR) was 76 years (67–82) and 43% were female. The median AFEQT summary score was 82 (67–94). Female sex, younger age, new onset AF, higher heart rate, obstructive sleep apnea, symptomatic heart failure (HF), chronic obstructive pulmonary disease and coronary artery disease were all independently associated with reduced QoL. Female sex [Estimate −7.03, 95% CI (−9.31, −4.75)] and new onset versus permanent AF [Estimate −7.44, 95% CI (−11.03, −3.84)] were independently associated with increased symptoms. NYHA Class III or IV HF [Estimate −14.44, 95% CI (−19.46, −8.76)] and female sex [Estimate −7.91, 95% CI (−9.95, −5.88)] were most independently associated with impaired daily activities.

Conclusions

QoL in patients with AF varies widely and is associated with several patient factors. Understanding patient factors independently associated with worse QoL can be a foundation for tailoring treatment.

Section snippets

Background

Atrial fibrillation (AF) significantly impairs quality of life (QoL) in many patients.1., 2. This impairment in QoL can be comparable to that observed in heart failure (HF) and is due to both the symptoms of the disease and end-organ complications, such as stroke.2., 3. At present, the major goal of rhythm management treatment is to improve patients' symptom burden and QoL. Given the fundamental importance of QoL considerations for AF patients, and its role in selecting AF treatment, there is

Methods

The Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT AF) is a large, nationwide observational cohort study with longitudinal follow-up of 2 years or more. The rationale and design of ORBIT AF has been described previously.11 In brief, ORBIT AF enrolled patients with AF from a variety of diverse clinical practice environments, including internal medicine, cardiology, and cardiac electrophysiology clinics. Patients with electrocardiographically confirmed AF were

Baseline characteristics

The median age was 76 (67–82), 43% were female, and the overall median CHA2DS2-VASC score was 4 (3–5). As shown in Table 2, physicians' assessments of patient symptoms were documented using the EHRA functional status assessment: 34% had no symptoms (EHRA class I), while 48%, 16%, and 2% had mild, severe, and disabling symptoms (EHRA classes II –IV respectively). Overall, 10% had first-detected AF; 48% had paroxysmal, 15% had persistent, and 28% had permanent AF. AFEQT score was lowest among

Discussion

In this dedicated analysis of AF-related QoL in over 2000 ambulatory patients, there are two important findings. First, many patient characteristics and comorbid diseases were independently associated with QoL in AF patients. Second, as expected, AFEQT scores were associated with patient-reported symptom assessments.

Conclusions

Several patient factors, both modifiable and non-modifiable, are associated with QoL in this patient population. Younger patients and women with AF had worse QoL, as did patients with comorbid diseases such as OSA, COPD, NYHA classes II-IV HF, hypertension, and obstructive coronary disease. These factors may serve both as targets for intervention as well as indicators for patients in whom a thorough QoL assessment is warranted. Armed with the knowledge of patient QoL, physicians can best advise

Sources of funding

The ORBIT AF registry is sponsored by Janssen Scientific Affairs, LLC, Raritan, NJ. Dr. Randolph was funded by National Institutes of Health T-32 Training Grant No. T32 HL 69749–11 Al. Dr. Chan received funding from the National Heart, Lung, and Blood Institute (1R01HL123980).

Disclosures

Fonarow reports modest consultant support from Janssen and Medtronic. Gersh reports: consulting support from Janssen, Xenon, Cipla Limited and Armethoen, Inc.; DSMB for Mount Sinai, St. Lukes, Boston Scientific, Teva Pharmaceutical Industries, St. Jude Medical, Janssen Research and Development, Baxter Healthcare Corporation, Cardiovascular Research Foundation, and Thrombosis Research Institute; advisory board for Medtronic. Kowey reports modest consultant support from Jonhnson and Johnson.

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    Anne B Curtis, MD served as guest editor for this article.

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