Atrial Fibrillation Symptoms and Sex, Race, and Psychological Distress

Gleason, Kelly; Nazarian, Saman; Himmelfarb, Cheryl Dennison

doi:10.1097/jcn.0000000000000421

Cited by 26 publications

(21 citation statements)

References 68 publications

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“…Women were more likely to report AF symptoms and poor AF-related quality of life than men. While previous studies have substantiated this association between sex and AF symptoms and quality of life [28, 53], cohort studies have found that women are less likely to receive rhythm control treatments that reduce symptom severity [54–56]. Symptoms of anxiety and depression were significantly more prevalent in women.…”

Section: Discussionmentioning

confidence: 98%

“…AF therapies, including rate and rhythm control medications, cardioversions, and ablation, are related to improvements in symptom experience, quality of life, functional status, and emotional status [20–27]. However, the effects of therapies on symptom experience and patient-reported outcomes are variable and very little is known about the influence of individual characteristics including sex, age, and education level on these outcomes [7, 28]. Females and older adults are significantly underrepresented in AF clinical trials [29–32].…”

Section: Introductionmentioning

confidence: 99%

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

Gleason

Himmelfarb

Ford

et al. 2019

BMC Cardiovasc Disord

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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.

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

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

Gleason

Himmelfarb

Ford

et al. 2019

BMC Cardiovasc Disord

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“…Some evidence suggests that non-White patients may have more symptoms with a greater impact on quality of life. 31 In addition, certain patients, such as those from a lower socioeconomic status, likely have a higher threshold to present for care unless substantial symptoms are present. Furthermore, even among those for whom a rhythm control strategy was selected (and therefore were presumably symptomatic or had other important indications for rhythm control), catheter ablation was used less frequently for patients from racial/ethnic minority groups and patients with a lower income.…”

Section: Discussionmentioning

confidence: 99%

Racial/Ethnic and Socioeconomic Disparities in Management of Incident Paroxysmal Atrial Fibrillation

et al. 2021

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IMPORTANCE In patients with paroxysmal atrial fibrillation (AF), rhythm control with either antiarrhythmic drugs (AADs) or catheter ablation has been associated with decreased symptoms, prevention of adverse remodeling, and improved cardiovascular outcomes. Adoption of advanced cardiovascular therapeutics, however, is often slower among patients from racial/ethnic minority groups and those with lower income. OBJECTIVE To ascertain the cumulative rates of AAD and catheter ablation use for the management of paroxysmal AF and to investigate for the presence of inequities in AF management by evaluating the association of race/ethnicity and socioeconomic status with their use in the United States. DESIGN, SETTING, AND PARTICIPANTS This cohort study obtained inpatient, outpatient, and pharmacy claims data from the Optum Clinformatics Data Mart between October 1, 2015, and June 30, 2019. Adult patients (aged Ն18 years) in the database with a diagnosis of incident paroxysmal AF were identified. Patients were excluded if they did not have continuous insurance enrollment for at least 1 year before and at least 6 months after study entry. EXPOSURES Race/ethnicity and zip code-linked median household income. MAIN OUTCOMES AND MEASURES Treatment with a rhythm control strategy, and catheter ablation specifically, among those who received rhythm control. Multivariable logistic regression models were used to assess the association of race/ethnicity and zip code-linked median household income with a rhythm control strategy (AADs or catheter ablation) vs a rate control strategy as well as with catheter ablation vs AADs among those receiving rhythm control. RESULTS Of the 109 221 patients who met the inclusion criteria, 55 185 were men (50.5%) and 73 523 were White (67.3%), with a median (interquartile range) age of 75 (68-82) years. A total of 86 359 patients (79.1%) were treated with rate control, 19 362 patients (17.7%) with AADs, and 3500 (3.2%) with catheter ablation. Between 2016 and 2019, the cumulative percentage of patients treated with catheter ablation increased from 1.6% to 3.8%. In multivariable analyses, Black race

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“…Previous studies reported that HRQoL is significantly impaired in patients with AF compared to the general population and patients with structural heart diseases [7,8]. However, there is controversy over the effects of sociodemographic (sex, level of activities), clinical (ejection fraction, comorbidity, stroke risk score, treatment methods), and psychological factors (stress, anxiety) on HRQoL in patients with AF [9,10,11]. Previous systematic reviews only covered symptom severity, HRQoL instruments used, and changes in HRQoL after rate/rhythm-control interventions [7,8,9,12].…”

Section: Introductionmentioning

confidence: 99%

Health-Related Quality of Life and Associated Factors in Patients with Atrial Fibrillation: An Integrative Literature Review

Son

Baek²,

Lee

et al. 2019

IJERPH

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Atrial fibrillation (AF) is a common cardiac arrhythmia associated with poor health-related quality of life (HRQoL). However, the factors influencing HRQoL in patients with AF are not well understood. The purpose of integrative review was to investigate the factors affecting HRQoL in patients with AF based on the six domains of Ferrans and colleagues’ HRQoL model. A total of 23 relevant articles published between January 2000 and March 2018 were identified using four databases and analyzed in this study. Our review showed that the HRQoL in patients with AF was consistently lower than both healthy individuals and patients with other cardiovascular diseases. The most common factor associated with HRQoL in patients with AF was anxiety-specific to AF in the symptoms domain, followed by frequency and severity of symptoms and the New York Heart Association functional class. This study highlights that monitoring and assessing patients’ symptoms is vital for improving HRQoL in patients with AF. Disease-specific and cross-culturally validated tools can allow healthcare professionals to provide tailored interventions for patients with AF.

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Atrial Fibrillation Symptoms and Sex, Race, and Psychological Distress

Cited by 26 publications

References 68 publications

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

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

Racial/Ethnic and Socioeconomic Disparities in Management of Incident Paroxysmal Atrial Fibrillation

Health-Related Quality of Life and Associated Factors in Patients with Atrial Fibrillation: An Integrative Literature Review

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