Impact of hospitalization on health-related quality of life in atrial fibrillation patients in Canada and the United States: Results from an observational registry

Abstract

Hospitalization is recognized as an important end point in atrial fibrillation (AF). The association between hospitalization and reduced health-related quality of life (HRQOL) has not been previously studied. The FRACTAL study was a prospective observational registry of patients enrolled in the United States and Canada with new-onset AF diagnosed by electrocardiogram. HRQOL was assessed with the SF-12 and the AF Symptom Checklist at baseline, 3, 6, 12, 24 and 30 months. Mixed linear regression models were fitted to estimate the impact of hospitalization on HRQOL summary scores, adjusting for demographic and baseline comorbid conditions known to influence HRQOL in this population. Of 933 subjects who completed questionnaires and were not hospitalized during the baseline study visit, 303 (32%) were hospitalized a total of 490 times during a mean of 2.0 years of follow-up. Most admissions (64%) were for cardiovascular causes. The adjusted effect of any hospital admission (vs none) on symptom frequency and severity scores over time was +1.3 and +1.1 points, respectively (P < .01 for both). The adjusted effect of any admission on the SF-12 physical score was -2.7 points (P < .0001) and on health state utility, -0.03 (P < .0001). In contrast, hospitalization had little effect on longitudinal Short Form 12 mental scores (-0.7 points, P = .15). Within 2 years after AF diagnosis, hospitalizations were associated with increased AF symptomatology and decrements in generic physical HRQOL and utilities. Based on these results, interventions that reduce admissions in AF patients may also improve or preserve HRQOL.