Clinical InvestigationPatient factors associated with quality of life in atrial fibrillation
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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2022, American Heart JournalCitation Excerpt :Third, patients in EAST-AFNET 4 were more likely to have cardiac comorbidities than those in the present study (HF prevalence: EAST-AFNET 4, 28.6%; current study, 18.4%; stroke prevalence: EAST-AFNET 4, 11.8%; current study 7.6%). As comorbidities affect the HRQoL in AF patients,19 these differences in patient characteristics might be associated with the discrepancy in HRQoL outcomes between EAST-AFNET 4 and our study. Caution should be exercised when interpreting our findings.
Anne B Curtis, MD served as guest editor for this article.