Quality Of Life In Atrial Fibrillation Research Articles

Managing With Atrial Fibrillation: An Exploratory Model-Based Cluster Analysis of Clinical and Personal Patient Characteristics

BackgroundExamining characteristics of patients with atrial fibrillation (AF) has the potential to help in identifying groups of patients who might benefit from different management approaches. MethodsSecondary analysis of online survey data was combined with clinic referral data abstraction from 196 patients with AF attending an AF specialty clinic. Cluster analyses were performed to identify distinct, homogeneous clusters of AF patients defined by 11 relevant variables: CHA2DS2-VASc score, age, AF symptoms, overall health, mental health, AF knowledge, perceived stress, household and recreation activity, overall AF quality of life, and AF symptom treatment satisfaction. Follow-up analyses examined differences between the cluster groups in additional clinical variables. ResultsEvidence emerged for both 2- and 4-cluster solutions. The 2-cluster solution involved a contrast between patients who were doing well on all variables (n = 129; 66%) vs those doing less well (n = 67; 34%). The 4-cluster solution provided a closer-up view of the data, showing that the group doing less well was split into 3 meaningfully different subgroups of patients who were managing in different ways. The final 4 clusters produced were as follows: (i) doing well; (ii) stressed and discontented; (iii) struggling and dissatisfied; and (iv) satisfied and complacent. ConclusionsPatients with AF can be accurately classified into distinct, natural groupings that vary in clinically important ways. Among the patients who were not managing well with AF, we found 3 distinct subgroups of patients who may benefit from tailored approaches to AF management and support. The tailoring of treatment approaches to specific personal and/or behavioural patterns, alongside clinical patterns, holds potential to improve patient outcomes (eg, treatment satisfaction).

Improvement in quality of life and cardiac function after catheter ablation for asymptomatic persistent atrial fibrillation.

BackgroundCatheter ablation (CA) for atrial fibrillation (AF) is widely performed. However, the indication for CA in patients with asymptomatic persistent AF is still controversial.MethodsAmong 259 consecutive patients who were hospitalized for initial CA of AF, a total of 45 patients who had asymptomatic persistent AF were retrospectively analyzed. Quality of life (QOL) before and 1 year after CA was evaluated, and changes in the cardiac function over 5 years after CA were also examined. QOL was assessed using the AF QOL questionnaire (AFQLQ) developed by the Japanese Heart Rhythm Society. In addition, cardiac function was assessed by measuring the plasma B‐type natriuretic peptide (BNP) level, left ventricular ejection fraction (LVEF), left atrial diameter (LAD) with transthoracic echocardiogram, and left atrial (LA) volume with computed tomography (CT).ResultsThe AFQLQ significantly improved after CA in terms of “symptom frequency” and “activity limits and mental anxiety.” The plasma BNP level, LVEF, and LAD significantly improved in the first 3 months after the first CA, with no significant changes thereafter (from 149.0 pg/dL [95% confidence intervals {CI}, 114.5‐183.5 pg/dL] to 49.8 pg/dL [95% CI, 26.5‐70.1], P < .0001; from 60.8% [95% CI, 58.1%–63.6%] to 65.0% [95% CI, 62.6‐67.4], P = .001; and from 41.3 mm [95% CI, 39.7‐42.9] to 36.8 [95% CI, 34.5‐39.1 mm], P < .0001, respectively). LA volume revealed LA reverse remodeling after CA.ConclusionImprovement in the QOL and cardiac function after CA of asymptomatic persistent AF was revealed. Asymptomatic persistent AF should be appropriately treated by CA.

Development and psychometric testing of the self-care scale for patients with chronic atrial fibrillation (AF-SCS-10).

Patients with atrial fibrillation (AF) require continuous self-care due to possible complications and side effects from treatment. However, existing tools do not capture all of the critical factors of AF self-care and have limited evidence of reliability and validity. The aim of this study was to develop and evaluate a new Atrial Fibrillation Self-Care Scale-10 (AF-SCS-10) that assesses disease-specific, multidimensional, person-centered self-care for AF patients in South Korea. For this cross-sectional research design, 290 individuals over 20 years of age with a diagnosis of AF for at least three months were recruited. A literature review and in-depth interviews were utilized to identify the scale items. An expert panel evaluated the validity and reliability of a preliminary scale. Exploratory factor analysis and parallel analysis was performed to extract factors; confirmatory factor analysis (CFA) was performed to evaluate fit on the factor structures. Criterion validity was supported by the correlation between AF-SCS-10 and AF quality of life. The internal consistency reliability coefficient was 0.87. Three factors, "self-care knowledge," "self-care behavior," and "self-care resources" were extracted from the exploratory factory analysis, explaining 79.30% of the total variance in the data. The three-factor model was also confirmed by parallel analysis; CFA met the fitness criteria. There is preliminary evidence for internal consistency reliability, as well as content and construct validity, for the AF-SCS-10. Future research is needed to confirm the study results using a larger, more culturally diverse sample.

P97 Effect of rhythm control therapy for asymptomatic atrial fibrillation

Abstract Background/Introduction Cather ablation (CA) for atrial fibrillation (AF) as rhythm control therapy has widely spread. However, the indication of CA for the patients with asymptomatic AF is controversial (2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS). Purpose This study was aimed to examine the effect of CA for asymptomatic AF patients. Methods In a total of 522 consecutive patients who were hospitalized for the initial CA for AF, 123 patients (23.6%) who were asymptomatic were retrospectively analyzed. "Asymptomatic AF" was defined when the patients had no complaints during the medical interviews. Quality of life (QOL) was evaluated with the AF QOL Questionnaire score (AFQLQ, invented by the Japanese Society of Electrocardiology) before CA and at 1 year after a single CA. Results A total of 79 patients were persistent AF (64.2%). Sinus rhythm maintenance rate at 3 yeas after CA was 57.0% in a single session and 84.8% in multiple sessions. In cardiac echo data at baseline, 3 months, 6 months, and 1 year after CA, left ventricular ejection fraction (LVEF) and left atrium diameter (LAD) were improved in the initial three months after a single CA (LVEF; 62.8 ± 8.0%→64.4 ± 6.5%, p = 0.045, LAD; 39.7 ± 6.1mm→35.3 ± 7.0mm, p = 0.0002). In LA volume measured with CT before and after CA, LA reverse remodeling was observed (102.7 ± 32.3ml→72.4 ± 24.1ml, p&amp;lt;.0001). In AFQLQ2 (severity of symptoms), there was no significant difference (16.3 ± 2.2→15.9 ± 1.7 out of 18, p = 0.69). However, in AFQLQ1 (frequency of symptoms) and AFQLQ3 (limitations of activities and mental anxiety), the score was improved (20.2 ± 4.5→23.4 ± 1.1 out of 24, p&amp;lt;.0001 and 47.6 ± 7.8→51.3 ± 6.1 out of 56, p = 0.0001). Moreover, in low LVEF patients (LVEF &amp;lt; 50%, n = 8), LVEF was remarkably improved (44.1 ± 4.0%→56.3 ± 10.8%, p = 0.034). Conclusions The improvement of LVEF and LA reverse remodeling can be expected at the early stage after CA, because of the reduction of AF burden. Moreover, the further improvement of QOL can be expected after CA, even in the patients with "asymptomatic" AF.

Paroxysmal atrial fibrillation recurrences and quality of life in symptomatic patients: A crossover study of flecainide and pilsicainide

BackgroundThe therapeutic goals of atrial fibrillation (AF) patients are to reduce symptoms and prevent severe complications associated with AF. This study compared the efficacy of flecainide versus pilsicainide in reducing the frequency of AF and improving quality of life (QOL) in symptomatic paroxysmal AF patients without structural heart disease. MethodsThe Atrial Fibrillation and Quality Of Life (AF-QOL) study was a prospective, multicenter, randomized, open-label crossover study that compared flecainide and pilsicainide as antiarrhythmic drug therapy. Patients were randomized to receive 3 months of treatment with flecainide twice daily or pilsicainide 3 times daily. Each treatment consisted of a dose-finding phase (weeks 1–4) and an efficacy phase (weeks 5–12). Forty-three patients completed the trial. The main outcome was the number of days with documented AF episodes using a patient-operated electrocardiogram. QOL questionnaires (SF-36 and AF-specific QOL scores) were also completed. ResultsThe median (range) AF frequencies (days/8 weeks) were 2 (0–50) in the flecainide treatment group and 1 (0–54) in the pilsicainide treatment group (no significant between-group difference). No significant difference in the first recurrence of AF during the efficacy phase was noted between flecainide and pilsicainide treatments. The frequency and severity scores of AF-related symptoms improved from baseline to the end of the treatment periods. No significant differences in SF-36 or AF-related QOL scores were noted between the treatment groups. ConclusionsThis study found no difference in AF frequency or QOL between symptomatic paroxysmal AF patients who received flecainide or pilsicainide.

Abstract 12228: Understanding the Gender Gap in Patients Undergoing Atrial Fibrillation Ablation: Women Delay Ablation Until Functionally Limited and Symptoms Are Severe

Introduction: The incidence of atrial fibrillation (AF) is nearly equivalent in men and women. Yet, existing literature indicates a gender gap in patients with atrial fibrillation presenting for ablation. We examine this discrepancy among patients undergoing AF ablation at The University of North Carolina hospital. Hypothesis: We hypothesized that gender differences in AF symptoms and functional capacity could account for the gender gap in patients undergoing AF ablation. Methods: A study of 178 consecutive patients presenting for AF ablation was conducted between October 2014 and May 2015. Prior to undergoing ablation, consenting patients completed the Duke Activity Status Index (DASI) evaluating functional capacity and the Atrial Fibrillation Effect on Quality-of-Life Questionnaire Tool (AFEQT) assessing AF-specific quality of life, symptom severity, treatment concern, and daily activities. Questionnaire data was analyzed with baseline demographics and comorbidities for gender differences. Results: Of 178 patients completing the baseline questionnaire, the proportion of men pursuing ablation (n=129, 72.5%) largely outweighed that of women (n=49, 27.5%). There were no gender differences in baseline demographics with the exception of significantly higher prevalence of obstructive sleep apnea (p&lt;0.001) and persistent AF in men (p&lt;0.05). Women presented for AF ablation with significantly lower functional capacity (p&lt;0.001), higher AF symptom severity (p&lt;0.05) and lower overall AF quality of life (p&lt;0.05) in comparison to men (Table). Conclusions: Our findings suggest that women do not present for AF ablation until symptoms are severe and functional capacity is low, likely contributing to the gender gap in AF ablation referrals. Whether this disparity is due to patient or provider factors requires further evaluation. Education of patients and providers regarding the potential efficacy and risks of ablation may help to bridge this gender gap.

Radiofrequency Catheter Ablation Improves the Quality of Life Measured with a Short Form-36 Questionnaire in Atrial Fibrillation Patients: A Systematic Review and Meta-Analysis.

BackgroundThe main purpose of performing radiofrequency catheter ablation (RFCA) in atrial fibrillation (AF) patients is to improve the quality of life (QoL) and alleviate AF-related symptoms. We aimed to determine the qualitative and quantitative effects of RFCA on the QoL in AF patients.MethodsWe performed a systemic review and meta-analysis using a random effects model. We searched for the studies that reported the physical component summary score (PCS) and mental component summary score (MCS) of the short form-36, a validated system to assess and quantify the QoL, before and after RFCA in AF patients. PCS and MCS are T-scores with a mean of 50 and standard deviation of 10.ResultsOf the 470 studies identified through systematic search, we included 13 studies for pre-RFCA vs. the post-RFCA analysis and 5 studies for treatment success vs. AF recurrence analyses. In the pre-RFCA vs. post-RFCA analysis, RFCA was associated with a significant increase in both the PCS (weighted mean difference [WMD] = 6.33 [4.81–7.84]; p < 0.001) and MCS (WMD = 7.80 [6.15–9.44]; p < 0.001). The ΔPCS (post-RFCA PCS–pre-RFCA PCS) and ΔMCS values were used for the treatment success vs. AF recurrence analysis. Patients with successful ablation had a higher ΔPCS (WMD = 7.46 [4.44–10.49]; p < 0.001) and ΔMCS (WMD = 7.59 [4.94–10.24]; p < 0.001).ConclusionsRFCA is associated with a significant increase in the PCS and MCS in AF patients. Patients without AF recurrence after RFCA had a better improvement in the PCS and MCS than patients who had AF recurrence.

Variation in Quality of Life With Type of Atrial Fibrillation

Atrial fibrillation (AF) is one of the most common arrhythmias. It is classified according to its presentation as either paroxysmal, persistent or permanent. The presence of this arrhythmia has been associated with a decrease in patients' health-related quality of life (HRQoL). The Atrial Fibrillation-Quality of Life (AF-QoL) questionnaire, which is specifically for use in patients with AF, has recently been developed and validated. The aim of this study was to use this questionnaire to investigate differences in HRQoL associated with different types of AF. This prospective observational multicenter study was performed in a regular clinical context in Spain. The AF-QoL questionnaire was administered to study patients, who were diagnosed as having one of the three types of AF. The study involved 341 patients with AF, 43% of whom had persistent AF, while 37% had paroxysmal AF, and 20% had permanent AF. Although the type of AF had no significant effect on the overall AF-QoL score, patients with permanent AF had the highest scores on the psychological dimension (i.e. better HRQoL). In addition, an increased frequency of symptoms, more emergency department visits, and poorer functioning were also associated with significant differences in HRQoL in AF patients. Use of the AF-QoL questionnaire showed that the HRQoL of AF patients was influenced by the clinical characteristics of the disease but not, except on the psychological dimension, by the type of AF.

Validation of a New Simple Scale to Measure Symptoms in Atrial Fibrillation

Background— Atrial fibrillation (AF) is commonly associated with impaired quality of life. There is no simple validated scale to quantify the functional illness burden of AF. The Canadian Cardiovascular Society Severity in Atrial Fibrillation (CCS-SAF) scale is a bedside scale that ranges from class 0 to 4, from no effect on functional quality of life to a severe effect on life quality. This study was performed to validate the scale. Methods and Results— In 484 patients with documented AF (62.2�12.5 years of age, 67% men; 62% paroxysmal and 38% persistent/permanent), the SAF class was assessed and 2 validated quality-of-life questionnaires were administered: the SF-36 generic scale and the disease-specific AFSS (University of Toronto Atrial Fibrillation Severity Scale). There is a significant linear graded correlation between the SAF class and measures of symptom severity, physical and emotional components of quality of life, general well-being, and health care consumption related to AF. Patients with SAF class 0 had age- and sex-standardized SF-36 scores of 0.15�0.16 and −0.04�0.31 (SD units), that is, units away from the mean population score for the mental and physical summary scores, respectively. For each unit increase in SAF class, there is a 0.36 and 0.40 SD unit decrease in the SF-36 score for the physical and mental components. As the SAF class increases from 0 to 4, the symptom severity score (range, 0 to 35) increases from 4.2�5.0 to 18.4�7.8 ( P &lt;0.0001). Conclusions— The CCS-SAF scale is a simple semiquantitative scale that closely approximates patient-reported subjective measures of quality of life in AF and may be practical for clinical use.

Synchronized biventricular pacing after av node ablation in CHF patients

Background atrioventricular junctional (AVJ) ablation with PM implantation has been shown to improve quality of life (QoL) in selected patients(pts) with drug resistant atrial fibrillation (AF). However,after the procedure,some pts worsen because of asinchronous ventricular stimulation. History during the last 9 years,among 1986 pts who referred to our Institution for AF, 28 pts underwent ablate and pace procedure by right ventricular single lead.The long term follow up(FU) of 36 months demonstrated an improvement of QoL in all but 4 pts who developed a progressive, irreversible heart failure. Methods from january 2001 to july 2002, 12 consecutive pts (6F,6M of mean age of 70.2 years) with dilated cardiomyopathy and chronic, non controlled high rate AF, were recruited. Eight pts had chronic persistant AF and 4 pts had chronic paroxismal AF. After AVJ ablation, a biventricular device was implanted : Medtronic Insync in 9 pts and Insync biventricular ICD in 3 pts. The NYHA functional class, the QRS duration, the mean heart rate, left ventricular ejection fraction (LVEF) and LV end diastolic dyameter (LVEDD) by 2D echocardiography, 6 minutes walking test(6'WT), the score of Minnesota questionnaire and the score of palpitation symptoms were evaluated at baseline and at 1, 3, 6 and 12 months FU in every pts. Results the mean FU was 7.2+/− 4 months.The results have been quite terrific as shown as follow. One pt,3 months after the procedure, in spite of wide clinical improvements, died suddenly on ecg Holter monitoring that demonstrated a ventricular fibrillation as the cause of death. In pts with paoxismal AF, a trend of reduction of numbers and duration of episodes of AF was observed. View this table: Conclusions these results demonstrated that the AVJ ablation combined with biventricular pacing is an effective tecnique to improve QoL in AF in congestive heart failure pts, mostly by relief of symptoms of palpitations and by means of the resinchronization therapy. The clinical results are not correlated to the QRS duration and to the LVEDD.Also the number of episodes of paroxismal AF seems to be lowered by the resnchronization therapy.However, life threatening ventricular arrhythmias have to be considered in pts without previous episodes.

Relation between variability of ventricular response intervals and exercise capacity in patients with non-valvular atrial fibrillation.

Reduced variability of the ventricular response interval (VRI) has been reported to predict adverse prognosis in patients with atrial fibrillation (AF). To examine whether it could be related also to the quality of the daily life of patients with AF, the relationships between VRI variability and exercise tolerance, one of the markers for quality of life, were determined in patients with persistent AF. Thirty-one patients with idiopathic AF were included in the present study. Holter monitoring results and symptom-limited treadmill exercise testing were correlated in these patients without medications for the rate control of AF. The VRI variability, both the SD of the mean R-R interval (SDNN) and the SD of the 5-min mean R-R interval (SDANN), showed significant positive correlation with the exercise capacity (r=0.583, p=0.0004, and r=0.543, p=0.0013, respectively), whereas age, left ventricular ejection fraction and body mass index did not have any significant relationships. Multiple regression analysis revealed that increased SDNN was the only independent predictor of good exercise capacity during the treadmill exercise testing. Increased VRI variability, independently of other clinical variables, can predict good exercise capacity in patients with idiopathic AF, thus being a new sensitive maker for quality of life in AF.