Abstract 12112: Establishing a Minimally Clinically Important Difference Threshold for Health-Related Quality of Life in Atrial Fibrillation: The SAGE-AF Study

Abstract

Introduction: Health related quality of life (HRQoL) is increasingly recognized as an important patient reported outcome but few research has focused on HRQoL meaningful changes overtime. Using data from Systematic Assessment of Geriatric Elements in Atrial Fibrillation, we identified clinically meaningful change over 1-year in older patients with AF and examined sociodemographic and geriatric factors associated with change. Methods and Results: Between 2016-18, 1,244 patients aged 65+ with atrial fibrillation (AF) were recruited from medical centers in Massachusetts and Georgia. At baseline and 1-year follow-up, patients completed validated HRQoL measure. We used a distribution-based approach to calculate a clinically meaningful threshold (9 points) and to define three groups: improve (N=154, 14%), stable, (N=617, 56%), and decline (N=326, 30%). Logistic regression was used to examine factors associated with clinically meaningful improvement and decline in HRQoL. CHA2DS2-VASC score was associated with an increased odds of HRQoL decline (adjusted odds ratio [AOR]= 1.16, 95% CI: 1.03, 1.32). Frailty (AOR= 1.89, 95% CI: 1.20, 2.92) and depression, (AOR=1.62, 95% CI: 1.17, 2.25) were associated with an increased odds of HRQoL improvement, while cognitive impairment (AOR= 0.72, 95% CI: 0.52, 0.99) was associated with a decreased odds of improvement in HRQoL. Conclusions: A change in HRQoL of 9-points was identified as clinically meaningful over 1-year in our cohort. The majority of patients remained stable in HRQoL over a year of follow-up. Understanding meaningful change in HRQoL can assist providers with knowing how to best treat their patients and develop strategies to improved or stabilize HRQoL.