Effect of Treatment Options on Quality of Life in Patients With Persistent or Recurrent Atrial Fibrillation: A Review of the Literature

Abstract

Introduction: Atrial fibrillation is well known for the resulting symptoms of fatigue, dyspnea, palpitations, angina, and lightheadedness that can adversely affect a patient’s quality of life. While the goal of atrial fibrillation management is to decrease symptoms and prevent further cardiac disease, overall improvement of the patient’s quality of life may be an important factor in deciding between rhythm and rate control pharmacologic therapy. Clinical Question: In patients with persistent or recurrent atrial fibrillation, is there a quality-of-life benefit to disease management using rhythm control or rate control pharmacologic methods? Search and Study Methods: Four multi-center, prospective, nonblinded, randomized controlled trials were identified through a PubMed database search. Three studies randomized participants to rhythm or rate control methods, while the fourth study evaluated two arms of rhythm control. The primary outcome of quality of life was measured by self-administered questionnaires and interviews for 12 months to 6 years. Results: The eleven assessment tools used among the studies revealed no difference in the quality of life between patients on rhythm and those on rate control pharmacologic therapy; measurements improved significantly, regardless of the treatment method. SF-36 summary scores indicated that physical aspects of quality of life improved significantly (p<0.05) in the first 3 years of treatment, while mental aspects improved significantly (p<0.02) or insignificantly. The greatest benefits were found in the categories of social and physical functioning. Symptom frequency and severity also improved significantly (p<0.01) as a result of rhythm or rate control. Conclusions: Patients with persistent or recurrent atrial fibrillation are likely to experience an improvement in the subjective perception of their health and well-being with either rhythm or rate control pharmacologic therapy. Both management strategies are associated with statistically significant improvements in quality-of-life measurements in the first 3 years of treatment. An important contributing factor to improvement is the successful management of symptoms.