Differences in Atrial Fibrillation Symptoms and Quality of Life and Response to Therapy Across Race-Ethnicity

Abstract

Objectives: To determine whether race-ethnicity modulates severity of atrial fibrillation (AF) symptoms, quality-of-life (QoL) and response to therapy. Background: Although the severity of AF symptoms is highly variable when selecting a rate or rhythm control approach, it remains unclear if race-ethnicity influences AF symptoms and QoL. Methods: We prospectively enrolled 453 patients with new-onset AF in a clinical-genetic registry. Baseline assessment of patients before treatment initiation included detailed patient history and administration of the Atrial Fibrillation Effect on QualiTy-of-life (AFEQT) questionnaire in African-Americans, European-Americans, and Hispanics/Latinos. We assessed AFEQT scores at baseline and average of 8 months after starting treatment on maximal doses. Results: Of 415 consecutive patients with AF, 181 (43.6%) were African-American, 139 (33.5%) European-American and 95 (22.9%) Hispanic/Latino with a mean age of 62.0{plus minus}13.1 years. Two-hundred fifteen (51.8%) were treated with rate control versus 200 (48.2%) with rhythm control. Both African-American (53.0%) and Hispanic/Latino (65.3%) patients were more likely to be initiated rate control as compared with European-Americans (41%; P=0.0002) despite lower baseline AFEQT scores (African-American: 73.6{plus minus}23.0; Hispanic/Latino: 74.8{plus minus}21.2; and European-American: 76.9{plus minus}20.6; P=0.05) and poorer QoL. In the rhythm control group, the AFEQT scores and QoL improved in African-Americans (ΔScore: 9.5{plus minus}26.0; P<0.001) and European-Americans (ΔScore: 9.7{plus minus}19.6; P<0.0001) and was associated with improvement in symptoms and activities of daily living. Multivariate predictors of improvement in QoL included rhythm therapy, obesity, coronary artery disease, and private health insurance. Conclusions: Our findings may have important clinical implications for the assessment of symptoms and management of AF in African-Americans and Hispanics/Latinos.