35 * Literature review of health related quality of life measurement tools for patients with atrial fibrillation: could they be used as a patient reported outcome measure?

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Introduction: The most common heart arrhythmia is atrial fibrillation (AF) where individuals can suffer symptoms that adversely affect health related quality of life (HRQoL). The main reason for rhythm control of AF is to reduce symptoms and improve patients HRQoL. Patient reported outcome measures (PROMs) were developed to measure patient's HRQoL to give an indication of improvement as a result of certain treatments. A variety of tools exist to measure HRQoL in patients with AF, these include generic measurement scales or disease specific tools. A literature review was carried out in 2013 to assess tools that measure HRQoL in AF and to consider if they had potential of being a PROM for clinical practice. Methods: Several online databases were used. Searches were restricted to those in English with full text and published from 2003-2013. Articles were excluded if it wasn't specified what tool was used, if a clinician reported outcome measure was used, if the tool was a generic HRQoL tool and where the study population wasn't AF. Results: 868 pieces of literature were identified to have used a HRQoL tool following the initial search: reduced to 26 after exclusion criteria was applied, with a total of 4 AF specific HRQoL tools which are listed below: Atrial Fibrillation Effect on Quality-of-Life (AFEQT) Development of a questionnaire to measure health-related quality of life in patients with atrial Fibrillation (AFQoL) Quality of Life of Atrial Fibrillation (AFQLQ) Quality of life in AF patients (QLAF) Each AF specific tool was examined in more detail, in particular their development, validation, application to clinical practice and limitations. 4 tools specific to AF were available to measure HRQoL. These tools have been developed in various ways, mostly based on literature reviews with all appearing to have a significant amount of clinical opinion alongside some patient input in initial stages. All mentioned tools have been validated alongside generic HRQoL tools and some with AF symptom scales. All these tools have shown to measure HRQoL but as most are made with principally clinician input in developmental stages, it is questionable if it can be classed as a PROM, thus having limited usefulness to the NHS in the collection of data. Conclusions: Due to the outcomes of this literature review it became evident how crucial the need for an AF specific PROM is. Development and validation of new HRQoL assessment tools with significant patient input in developmental stages would be beneficial to assist clinicians to decide patient treatments in clinical practice. It would further ensure that research in AF regarding HRQoL treatment is measured effectively and accurately providing an indication of the effectiveness of these treatments. An AF specific PROM recognised by the NHS could to be used in a similar way to other disease specific PROMs nationwide to compare outcomes of treatments.