Jacqueline Jones1, Mary Stanbury1, Sandra Haynes1, Karina V Bunting2,3, Trudie Lobban4, A John Camm5, Melanie J Calvert6,7,8, Dipak Kotecha9,10,11. 1. Patient and Public Involvement Team, RATE-AF trial, Birmingham, United Kingdom. 2. Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom. 3. University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom. 4. Arrhythmia Alliance and Atrial Fibrillation Association, Chipping Norton, United Kingdom. 5. St. George's University of London, London, United Kingdom. 6. Institute of Applied Health Research & National Institute for Health Research Biomedical Research Centre, University of Birmingham, Birmingham, United Kingdom. 7. Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, United Kingdom. 8. Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, United Kingdom. 9. Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom, D.Kotecha@bham.ac.uk. 10. University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom, D.Kotecha@bham.ac.uk. 11. Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, United Kingdom, D.Kotecha@bham.ac.uk.
Abstract
AIMS: To establish the extent and impact of symptoms in patients with atrial fibrillation (AF), the importance of different aspects of quality of life (QoL), and how we should assess wellbeing. METHODS: Focus groups of patients with symptomatic permanent AF in a trial of heart rate control; the RATE-AF trial randomised 160 patients aged ≥60 years with permanent AF and at least NYHA class II dyspnoea to eitherdigoxin or beta-blockers. Patient and public representatives led the focus groups and performed all data acquisition and analysis, using thematic approaches to interpret patient views about QoL and its measurement. RESULTS: Substantial impairment of health-related QoL was noted in 160 trial patients, with impact on all domains apart from mental health. Eight women and 11 men aged 61-87 years participated in the focus groups. Common themes were a lack of information from healthcare professionals about AF, a lack of focus on QoL in consultations, and a sense of frustration, isolation, and reduced confidence. There was marked variability in symptoms in individual patients, with some describing severe impact on activities of daily living, and profound interaction with comorbidities such as arthritis. Day-to-day variation in QoL and difficulty in attributing symptom burden to AF or other comorbidities led to challenges in questionnaire completion. Consensus was reached that collecting both general and AF-specific QoL would be useful in routine practice, along with participation in peer support, which was empowering for the patients. CONCLUSIONS: The impact of comorbidities is poorly appreciated in the context of AF, with considerable variability in QoL that requires both generic and AF-specific assessment. Improvement in QoL should direct the appraisal, and reappraisal, of treatment decisions for patients with permanent AF.
RCT Entities:
AIMS: To establish the extent and impact of symptoms in patients with atrial fibrillation (AF), the importance of different aspects of quality of life (QoL), and how we should assess wellbeing. METHODS: Focus groups of patients with symptomatic permanent AF in a trial of heart rate control; the RATE-AF trial randomised 160 patients aged ≥60 years with permanent AF and at least NYHA class II dyspnoea to either digoxin or beta-blockers. Patient and public representatives led the focus groups and performed all data acquisition and analysis, using thematic approaches to interpret patient views about QoL and its measurement. RESULTS: Substantial impairment of health-related QoL was noted in 160 trial patients, with impact on all domains apart from mental health. Eight women and 11 men aged 61-87 years participated in the focus groups. Common themes were a lack of information from healthcare professionals about AF, a lack of focus on QoL in consultations, and a sense of frustration, isolation, and reduced confidence. There was marked variability in symptoms in individual patients, with some describing severe impact on activities of daily living, and profound interaction with comorbidities such as arthritis. Day-to-day variation in QoL and difficulty in attributing symptom burden to AF or other comorbidities led to challenges in questionnaire completion. Consensus was reached that collecting both general and AF-specific QoL would be useful in routine practice, along with participation in peer support, which was empowering for the patients. CONCLUSIONS: The impact of comorbidities is poorly appreciated in the context of AF, with considerable variability in QoL that requires both generic and AF-specific assessment. Improvement in QoL should direct the appraisal, and reappraisal, of treatment decisions for patients with permanent AF.
Authors: Dipak Kotecha; Karina V Bunting; Simrat K Gill; Samir Mehta; Mary Stanbury; Jacqueline C Jones; Sandra Haynes; Melanie J Calvert; Jonathan J Deeks; Richard P Steeds; Victoria Y Strauss; Kazem Rahimi; A John Camm; Michael Griffith; Gregory Y H Lip; Jonathan N Townend; Paulus Kirchhof Journal: JAMA Date: 2020-12-22 Impact factor: 56.272
Authors: Jordan L Lacoste; Thomas W Szymanski; Juan Carlo Avalon; Galen Kabulski; Utkarsh Kohli; Nassir Marrouche; Atul Singla; Sudarshan Balla; Arshad Jahangir Journal: Am J Cardiovasc Drugs Date: 2022-03-30 Impact factor: 3.283
Authors: Luc J H J Theunissen; Henricus-Paul Cremers; Dennis van Veghel; Pepijn H van der Voort; Peter E Polak; Sylvie F A M S de Jong; Geert Smits; Jos Dijkmans; Hareld M C Kemps; Lukas R C Dekker; Jeroen A A van de Pol Journal: J Arrhythm Date: 2022-01-10