The following is a summary of “Longitudinal Changes in Health‐Related Quality of Life in Patients With Atrial Fibrillation,” published in the October 2023 issue of Cardiology by Witassek et al.
Achieving optimal health-related quality of life (HRQoL) remains a crucial goal in treating atrial fibrillation (AF), yet there’s limited knowledge about the long-term HRQoL trends in patients and how various patient and disease factors impact these trajectories. This study aimed to delineate HRQoL patterns over an extended period among patients in an observational AF study and distinct patient clusters with similar characteristics.
Utilizing five-year follow-up data from the Swiss-Atrial Fibrillation prospective cohort, consisting of 2,415 patients diagnosed with prevalent AF between 2014 and 2017, the researchers annually collected HRQoL information that included EuroQoL-5 dimension utilities and EuroQoL visual analog scale scores. Hierarchical clustering identified patient clusters with comparable enrollment characteristics. The study group conducted descriptive analyses of HRQoL trajectories and used inverse probability-weighted regressions.
Additionally, the investigators evaluated the effects of clinical events occurring post-baseline using time-shifted event variables. Of the 2412 patients with baseline HRQoL data available, three distinct AF patient clusters emerged: “cardiovascular-dominated,” “isolated symptomatic,” and “severely morbid without cardiovascular disease.” Over time, both utilities and EuroQoL visual analog scale scores remained relatively consistent for the entire patient population and within each cluster, with isolated symptomatic patients demonstrating higher HRQoL levels. Notably, after occurrences of stroke, heart failure hospitalization, and bleeding, utilities experienced reductions of -0.12 (95% CI, -0.18 to -0.06), -0.10 (95% CI, -0.13 to -0.08), and -0.06 (95% CI, -0.08 to -0.04), respectively, on a 0 to 1 utility scale. Surviving patients’ utility levels returned to pre-event levels approximately 4 years after heart failure hospitalization, 3 years after bleeding, and 1 year following stroke.
Among prevalent AF patients, HRQoL remained relatively stable over time, regardless of initial patient characteristics. Clinical events such as heart failure hospitalization, stroke, and bleeding had only transient impacts on HRQoL, with patients eventually returning to pre-event levels.