Association of sex, age and education level with patient reported outcomes in atrial fibrillation

Abstract

Background In atrial fibrillation (AF), there are known sex and sociodemographic disparities in clinical outcomes such as stroke. We investigate whether disparities also exist with respect to patient-reported outcomes. We explored the association of sex, age, and education level with patient-reported outcomes (AF-related quality of life, symptom severity, and emotional and functional status). Methods The PaTH AF cohort study recruited participants ( N = 953) with an AF diagnosis and age ≥ 18 years across 4 academic medical centers. We performed longitudinal multiple regression with random effects to determine if individual characteristics were associated with patient-reported outcomes. Results Women reported poorer functional status (β − 2.23, 95% CI: -3.52, − 0.94) and AF-related quality of life (β − 4.12, 95% CI: -8.10, − 0.14), and higher symptoms of anxiety (β 2.08, 95% CI: 0.76, 3.40), depression (β 1.44, 95% CI: 0.25, 2.63), and AF (β 0.29, 95% CI: 0.08, 0.50). Individuals < 60 years were significantly ( p < 0.05) more likely to report higher symptoms of depression, anxiety, and AF, and poorer AF-related quality of life. Lack of college education was associated with reporting higher symptoms of AF (β 0.42, 95% CI: 0.17, 0.68), anxiety (β 1.86, 95% CI: 0.26, 3.45), and depression (β 1.11, 95% CI: 0.15, 2.38), and lower AF-related quality of life (β − 4.41, 95% CI: -8.25, − 0.57) and functional status. Conclusion Women, younger adults, and individuals with lower levels of education reported comparatively poor patient-reported outcomes. These findings highlight the importance of understanding why individuals experience AF differently based on certain characteristics.

Psychological aspects of atrial fibrillation: A systematic narrative review

“…Data from the Women's Health Study also showed a significant association between traumatic life events and AF [85], and positive affect was associated with reduced AF risk [12]. Similarly, in the PaTH AF cohort study (N = 953, mean age = 72 ± 10, 65% male), female sex was associated with higher AF symptom severity and greater symptoms of anxiety and depression [86]. Additionally, a study in patients with recurrent AF (N = 93) demonstrated that depression mediated the effect of gender on physical health, whereby the increased susceptibility of female AF patients to depressive symptoms might be a major contributing factor to their poorer physical health compared to their male counterparts [87].…”

Association of income and educational attainment in hospitalization events in atrial fibrillation

“…Study of how educational attainment contributes to outcomes in AF remains limited. Education has been examined in chronic conditions such as cardiovascular disease, with lower educational attainment being associated with a higher prevalence of cardiovascular risk factors and events [ [29] , [30] , [31] ]. Multiple pathways may explain the relation of educational attainment and clinical adversity, such as the hospitalization rates observed in the current study.…”

Association of sex and atrial fibrillation therapies with patient-reported outcomes

“…Our previous study in this cohort found that women were more likely to report AF symptoms and poorer quality of life than men. 25 We conducted this study to build on this finding by exploring if sex differences in rhythm and rate control therapies received accounts for the higher symptom severity experienced by women, since women are less likely to receive rhythm control treatments including cardioversions and ablations that reduce symptom severity. [7][8][9] We found that sex differences in AF symptoms severity and quality of life persisted after we accounted for rate and rhythm therapies received by creating matched samples.…”