James V Freeman1, DaJuanicia N Simon2, Alan S Go2, John Spertus2, Gregg C Fonarow2, Bernard J Gersh2, Elaine M Hylek2, Peter R Kowey2, Kenneth W Mahaffey2, Laine E Thomas2, Paul Chang2, Eric D Peterson2, Jonathan P Piccini2. 1. From the Yale University School of Medicine, New Haven, CT (J.V.F.); Duke Clinical Research Institute, Durham, NC (D.N.S., L.E.T., E.D.P., J.P.P.); Division of Research, Kaiser Permanente of Northern California, Oakland, CA (A.S.G.); Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City (J.S.); Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.); Mayo Clinic Medical Center, Rochester, Minnesota (B.J.G.); Boston University Medical Center, Boston, MA (E.M.H.); Lankenau Institute for Medical Research and Jefferson Medical College, Philadelphia, PA (P.R.K.); and Stanford University School of Medicine, Stanford, CA (K.W.M.); Janssen Pharmaceuticals Inc., Bridgewater, NJ (P.C.). james.freeman@yale.edu. 2. From the Yale University School of Medicine, New Haven, CT (J.V.F.); Duke Clinical Research Institute, Durham, NC (D.N.S., L.E.T., E.D.P., J.P.P.); Division of Research, Kaiser Permanente of Northern California, Oakland, CA (A.S.G.); Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City (J.S.); Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.); Mayo Clinic Medical Center, Rochester, Minnesota (B.J.G.); Boston University Medical Center, Boston, MA (E.M.H.); Lankenau Institute for Medical Research and Jefferson Medical College, Philadelphia, PA (P.R.K.); and Stanford University School of Medicine, Stanford, CA (K.W.M.); Janssen Pharmaceuticals Inc., Bridgewater, NJ (P.C.).
Abstract
BACKGROUND: Instruments to assess symptom burden and quality of life among patients with atrial fibrillation (AF) have not been well evaluated in community practice or associated with patient outcomes. METHODS AND RESULTS: Using data from 10 087 AF patients in the Outcomes Registry for Better Informed Treatment of AF (ORBIT-AF), symptom severity was evaluated using the European Heart Rhythm Association (EHRA) classification system, and quality of life was assessed using the Atrial Fibrillation Effect on Quality-of-Life (AFEQT) questionnaire. The association between AF-related symptoms, quality of life, and outcomes was assessed using Cox regression. The majority of AF patients (61.8%) were symptomatic (EHRA >2) and 16.5% had severe or disabling symptoms (EHRA 3-4). EHRA symptom class was well correlated with the AFEQT score (Spearman correlation coefficient -0.39). Over 1.8 years of follow-up, AF symptoms were associated with a higher risk of hospitalization (adjusted hazard ratio for EHRA ≥2 versus EHRA 1 1.23, 95% confidence interval, 1.15-1.31) and a borderline higher risk of major bleeding. Lower quality of life was associated with a higher risk of hospitalization (adjusted hazard ratio for lowest quartile of AFEQT versus highest 1.49, 95% confidence interval, 1.2-1.84), but not other major adverse events, including death. CONCLUSIONS: In a community-based study, most patients with AF were symptomatic and had impaired quality of life. Quality of life measured by the AFEQT correlated closely with symptom severity measured by the EHRA class. AF symptoms and lower quality of life were associated with higher risk of hospitalization but not mortality during follow-up.
BACKGROUND: Instruments to assess symptom burden and quality of life among patients with atrial fibrillation (AF) have not been well evaluated in community practice or associated with patient outcomes. METHODS AND RESULTS: Using data from 10 087 AFpatients in the Outcomes Registry for Better Informed Treatment of AF (ORBIT-AF), symptom severity was evaluated using the European Heart Rhythm Association (EHRA) classification system, and quality of life was assessed using the Atrial Fibrillation Effect on Quality-of-Life (AFEQT) questionnaire. The association between AF-related symptoms, quality of life, and outcomes was assessed using Cox regression. The majority of AFpatients (61.8%) were symptomatic (EHRA >2) and 16.5% had severe or disabling symptoms (EHRA 3-4). EHRA symptom class was well correlated with the AFEQT score (Spearman correlation coefficient -0.39). Over 1.8 years of follow-up, AF symptoms were associated with a higher risk of hospitalization (adjusted hazard ratio for EHRA ≥2 versus EHRA 1 1.23, 95% confidence interval, 1.15-1.31) and a borderline higher risk of major bleeding. Lower quality of life was associated with a higher risk of hospitalization (adjusted hazard ratio for lowest quartile of AFEQT versus highest 1.49, 95% confidence interval, 1.2-1.84), but not other major adverse events, including death. CONCLUSIONS: In a community-based study, most patients with AF were symptomatic and had impaired quality of life. Quality of life measured by the AFEQT correlated closely with symptom severity measured by the EHRA class. AF symptoms and lower quality of life were associated with higher risk of hospitalization but not mortality during follow-up.
Authors: Emilio Márquez-Contreras; Nieves Martell-Claros; Vicente Gil-Guillén; Mariano De la Figuera-Von Wichmann; Eugenio Sánchez-López; Ines Gil-Gil; Sara Márquez-Rivero Journal: Qual Life Res Date: 2017-01-06 Impact factor: 4.147
Authors: Verena Semmler; Felix von Krogh; Bernhard Haller; Tilko Reents; Felix Bourier; Marta Telishevska; Marc Kottmaier; Marielouise Kornmayer; Stephanie Brooks; Katharina Koch-Büttner; Carsten Lennerz; Amir Brkic; Christian Grebmer; Patrick Blazek; Severin Weigand; Gabriele Hessling; Christof Kolb; Isabel Deisenhofer Journal: Clin Res Cardiol Date: 2018-11-20 Impact factor: 5.460
Authors: Megan M Streur; Sarah J Ratcliffe; David J Callans; M Benjamin Shoemaker; Barbara J Riegel Journal: Pacing Clin Electrophysiol Date: 2018-05-15 Impact factor: 1.976
Authors: Tiffany C Randolph; DaJuanicia N Simon; Laine Thomas; Larry A Allen; Gregg C Fonarow; Bernard J Gersh; Peter R Kowey; James A Reiffel; Gerald V Naccarelli; Paul S Chan; John A Spertus; Eric D Peterson; Jonathan P Piccini Journal: Am Heart J Date: 2016-08-19 Impact factor: 4.749