Factors Associated with Large Improvements in Health-Related Quality of Life in Patients with Atrial Fibrillation: Results from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF). Circulation. Arrhythmia and electrophysiology Steinberg, B. A., Holmes, D. N., Pieper, K. n., Allen, L. A., Chan, P. S., Ezekowitz, M. D., Freeman, J. V., Fonarow, G. C., Gersh, B. J., Hylek, E. M., Kowey, P. R., Mahaffey, K. W., Naccarelli, G. n., Reiffel, J. n., Singer, D. E., Peterson, E. D., Piccini, J. P. 2020


Background - Atrial fibrillation (AF) adversely impacts health-related quality of life (hrQoL). While some patients demonstrate improvements in hrQoL, the factors associated with large improvements in hrQoL are not well described. Methods - We assessed factors associated with a 1-year increase in AFEQT of 1 standard deviation (=18 points; 3x clinically important difference), among outpatients in the ORBIT-AF I registry. Results - Overall, 28% (181/636) of patients had such a hrQoL improvement. Compared with patients not showing large hrQoL improvement, they were of similar age (median 73 vs. 74, p=0.3), equally likely to be female (44% vs. 48%, p=0.3), but more likely to have newly-diagnosed AF at baseline (18% vs. 8%; p=0.0004), prior antiarrhythmic drug use (52% vs. 40%, 0.005), baseline antiarrhythmic drug use (34.8% vs, 26.8%, p=0.045), and more likely to undergo AF-related procedures during follow-up (AF ablation: 6.6% vs. 2.0%, p=0.003; cardioversion:12.2% vs. 5.9% p=0.008). In multivariable analysis, a history of alcohol abuse (adjusted OR 2.41, p=0.01) and increased baseline diastolic BP (adjusted OR 1.23 per 10-point increase and >65 mm Hg, p=0.04) were associated with large improvements in hrQoL at 1 year, whereas patients with prior stroke/TIA, COPD, and PAD were less likely to improve (p<0.05 for each). Conclusions - In this national registry of AF patients, potentially treatable AF risk factors are associated with large hrQoL improvement, whereas less reversible conditions appeared negatively associated with hrQoL improvement. Understanding which patients are most likely to have large hrQoL improvement may facilitate targeting interventions for high-value care that optimizes patient reported outcomes in AF. Clinical Trial Registration - clinicaltrials.gov.; Unique Identifier: NCT01165710.

View details for DOI 10.1161/CIRCEP.119.007775

View details for PubMedID 32298144