10 Jun Most Patients With Atrial Fibrillation Are Symptomatic and Have Impaired Quality of Life
MedicalResearch.com Interview with:
James V. Freeman MD, MPH, MS
Yale University School of Medicine
New Haven, CT
Medical Research: What is the background for this study? What are the main findings?
Dr. Freeman: Atrial fibrillation (AF) substantially increases the risk of major adverse clinical outcomes such as stroke and death, but it can also cause frequent symptoms, affect patient’s functional status, and impair their quality of life. While prior studies have reported the range of AF-related symptoms in patient populations, these studies were generally from highly selected patients and referral based practices, and may not reflect results in community practice or results with contemporary AF management. Using the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF), a large, contemporary, prospective, community-based outpatient cohort, we evaluated the type and frequency of symptoms in patients with Atrial fibrillation. In addition, we measured the degree to which physician assessed symptom severity (using the European Heart Rhythm Association [EHRA] classification system) was correlated with patient reported quality of life (assessed by the Atrial Fibrillation Effect on QualiTy-of-life [AFEQT] questionnaire). Finally, we association between symptoms or quality of life with clinical outcomes, including death, hospitalization, stroke and major bleeding.
In our community-based study, the majority of AF patients (61.8%) were symptomatic (EHRA >2) and 16.5% had severe or disabling symptoms (EHRA 3-4). EHRA symptom class was well correlated with the AFEQT quality of life score (Spearman correlation coefficient -0.39). Over 1.8 years of follow-up, Atrial fibrillation symptoms were associated with a higher risk of hospitalization (adjusted HR for EHRA ≥2 vs EHRA 1 1.23, 95% CI 1.15-1.31) and a borderline higher risk of major bleeding. Lower quality of life was associated with a higher risk of hospitalization (adjusted HR for lowest quartile of AFEQT vs highest 1.49, 95% CI 1.2-1.84), but not other major adverse events including death.
Medical Research: What should clinicians and patients take away from your report?
Dr. Freeman: In our community-based study, most patients with Atrial fibrillation were symptomatic and had impaired quality of life. Patient-reported quality of life correlated closely with physician-assessed symptom severity. AF symptoms and lower quality of life were associated with higher risk of hospitalization but not mortality during follow-up. This finding is noteworthy because the patients with the highest burden of symptoms and the lowest quality of life were substantially younger and healthier than less symptomatic patients and those with higher self-reported quality of life. These patients did not have an increased risk of death, stroke, myocardial infarction or major bleeding, suggesting that their hospitalizations were likely related to their symptoms and lower quality of life and not major adverse event.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Freeman: We need further validation of the EHRA and AFEQT scoring systems as objective means of evaluating AF related symptom burden and quality of life, respectively. In addition, we need more studies evaluating interventions targeted at improvement in symptoms and quality of life in the patients with the highest symptom burden and lowest quality of life due to AF to see if we can decrease their risk for hospitalization and resource utilization. Possible interventions worthy of study include aggressive AF outpatient follow-up or Atrial fibrillation rhythm control therapies.
Association Between Atrial Fibrillation Symptoms, Quality of Life, and Patient Outcomes: Results From the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF).
James V. Freeman, DaJuanicia N. Simon, Alan S. Go, John Spertus, Gregg C. Fonarow, Bernard J. Gersh, Elaine M. Hylek, Peter R. Kowey, Kenneth W. Mahaffey, Laine E. Thomas, Paul Chang, Eric D. Peterson, and Jonathan P. Piccini
Circ Cardiovasc Qual Outcomes. 2015;CIRCOUTCOMES.114.001303published online before print June 9 2015, doi:10.1161/CIRCOUTCOMES.114.001303
James V. Freeman MD, MPH, MS, Yale University School of Medicine, & New Haven, CT (2015). Most Patients With Atrial Fibrillation Symptomatic and Have Impaired Quality of Life