Health-related quality of life in patients with atrial fibrillation: The role of symptoms, comorbidities, and the type of atrial fibrillation.

Fabienne Witassek,Christian Sticherling,Jürg H Beer,For The Swiss-Af Study Investigators ,Anne Springer,Luise Adam,Michael Kühne,Stefanie Aeschbacher,Steffen Blum,Richard Kobza,Stefan Osswald,David Conen,Thomas Szucs,Leo H Bonati,Giorgio Moschovitis,Matthias Schwenkglenks,Nicolas Rodondi

doi:10.1371/journal.pone.0226730

Abstract

AimsThis study aimed to analyse health related quality of life (HRQoL) for patients with different atrial fibrillation (AF) types and to identify patient characteristics, symptoms and comorbidities that influence HRQoL.MethodsWe used baseline data from the Swiss Atrial Fibrillation (Swiss-AF) study, a prospective multicentre observational cohort study conducted in 13 clinical centres in Switzerland. Between April 2014 and August 2017, 2415 AF patients were recruited. Patients were included in this analysis if they had baseline HRQoL data as assessed with EQ-5D-based utilities and visual analogue scale (VAS) scores. Patient characteristics and HRQoL were described stratified by AF type. The impact of symptoms, comorbidities and socio-economic factors on HRQoL was analysed using multivariable regression analysis.ResultsBased on 2412 patients with available baseline HRQoL data, the lowest unadjusted mean HRQoL was found in patients with permanent AF regardless of whether measured with utilities (paroxysmal: 0.83, persistent: 0.84, permanent: 0.80, p<0.001) or VAS score (paroxysmal: 73.6, persistent: 72.8, permanent: 69.2, p<0.001). In multivariable analysis of utilities and VAS scores, higher European Heart Rhythm Association (EHRA) score, recurrent falls and several comorbidities showed a strong negative impact on HRQoL while AF type was no longer associated with HRQoL.ConclusionsMultiple factors turned out to influence HRQoL in AF patients. After controlling for several comorbidities, the EHRA score was one of the strongest predictors independent of AF type. The results may be valuable for better patient assessment and provide a reference point for further QoL and health economic analyses in AF populations.

Highlights

Atrial fibrillation (AF), the most common cardiac arrhythmia with an estimated prevalence of 2% in the general adult population of Europe [1], is associated with a broad range of symptoms such as palpitations, dyspnoea, chest tightness, lethargy, sleeping difficulties, and psychosocial distress [2]
Based on 2412 patients with available baseline health-related quality of life (HRQoL) data, the lowest unadjusted mean HRQoL was found in patients with permanent AF regardless of whether measured with utilities or visual analogue scale (VAS) score
Health-related quality of life in patients with atrial fibrillation provided on the Swiss-AF website

Summary

Introduction

Atrial fibrillation (AF), the most common cardiac arrhythmia with an estimated prevalence of 2% in the general adult population of Europe [1], is associated with a broad range of symptoms such as palpitations, dyspnoea, chest tightness, lethargy, sleeping difficulties, and psychosocial distress [2]. In addition to the burden of the disease itself, patients with AF face an increased risk for major complications such as heart failure, cognitive impairment, and stroke [3]. All these factors may, depending on their grade of manifestation, impact the health-related quality of life (HRQoL) of AF patients. Other studies demonstrated that comorbid conditions were more strongly related with HRQoL than the clinical manifestations of AF itself [7, 8], and that HRQoL was mainly impaired in newly diagnosed patients and rose to a normal level with standard treatment [7]. A further study showed that HRQoL was significantly impacted by AF type and symptoms in addition to comorbidities, regardless of disease duration [9]

Methods

Results

Conclusion