Baseline and Postprocedural Health Status Outcomes in Contemporary Patients With Atrial Fibrillation Who Underwent Catheter Ablation: A Report from the Japanese Outpatient Registry

Abstract

Background Randomized clinical trials have demonstrated that catheter ablation (CA) for atrial fibrillation improves health‐related quality of life (HRQoL). In daily practice, however, CA is performed on a wide range of patients, and outcomes may vary. We aimed to examine baseline and 1‐year HRQoL outcomes of patients with atrial fibrillation after CA in daily practice. Methods and Results Using a registry‐based cohort study designed to recruit patients with atrial fibrillation newly referred to 11 hospitals, we extracted data from 1097 consecutive patients with atrial fibrillation who underwent CA between 2012 and 2019. The Atrial Fibrillation Effects on Quality of Life Overall Summary (AFEQT‐OS) was assessed at registration and 1 year after, and a 5‐point increase in AFEQT‐OS score was considered a meaningful improvement. Overall, the median age was 64 (interquartile range, 56–70) years, 836 (76.2%) were men, and 93.0% (n=1021) of the patients answered the AFEQT questionnaire. The mean AFEQT‐OS score was 74.9 (SD, 18.0) at registration and 88.8 (SD, 12.6) at 1 year after. Notably, the incidence of meaningful improvement in HRQoL after CA was 88.6% for the patients with impaired HRQoL (AFEQT‐OS score <80), which was only 40.1% in those with preserved HRQoL (AFEQT‐OS score ≥80). Female sex, left atrium diameter, and high baseline HRQoL were independently associated with nonimprovement after CA. Conclusions The improvement in HRQoL after CA was similar to that seen in clinical trials; however, one‐third of patients did not show improvement. These results underscore the importance of quantitative evaluation of patients’ HRQoL to maximize the effect of CA before its performance.

Sociodemographic, Clinical and Geriatric Characteristics Associated with Poor Atrial Fibrillation-Related Quality of Life in Older Adults with Atrial Fibrillation: A cross-sectional study

“…In the present study, the average AFEQT score at baseline was 80.0 (SD: 18.0), while average scores in previous studies have ranged from 73 to 87 [13,20,[30][31][32]. Differences in our results compared to previous research may be due to differences in cohort symptom severity, smaller sample sizes [13,30,32], AF symptom treatment differences [31] and the methods used to recruit patients into these research studies (i.e.…”

“…Differences in our results compared to previous research may be due to differences in cohort symptom severity, smaller sample sizes [13,30,32], AF symptom treatment differences [31] and the methods used to recruit patients into these research studies (i.e. registries, hospital patients, clinic settings) [20,32].…”

“…The rst 18 items on the AFEQT scale ask questions about symptoms, ability to perform daily tasks, ability to engage in various forms of exercise/ tness, bothersome feelings, and worrying. We considered AFEQT scores < 80 to indicate poor AFQoL and scores ≥ 80 to indicate good AFQoL based on prior published studies [20][21][22].…”

Left Ventricular Diastolic Indices and Their Impact on Outcomes in Patients with Recently Diagnosed Atrial Fibrillation

“…To investigate whether the incidence of LVDD was associated with impaired HR-QoL (AFEQT-OS scores < 80) at enrollment, we constructed a logistic regression model with generalized estimating equations to account for clustering of patients within sites and adjusted for aforementioned clinically relevant variables. Further, we performed a sub-group analysis for LA diameter (e.g., LA diameter < 40 mm or ≥40 mm), as LA dilatation is reportedly associated with worse HR-QoL among AF patients [ 9 ]. In order to ensure that we examined a representative cohort of patients, we examined differences in the baseline characteristics between those with and without available AFEQT data.…”

“…Recent studies have indicated that AF could be an early manifestation of underlying left atrial failure, which leads to or is derived from left ventricular (LV) diastolic dysfunction (LVDD) [ 7 , 8 ]. Beyond understanding LV ejection fraction (EF), LVDD provides independent and incremental prognostic information on patients with established HF [ 9 ]. However, whether LVDD indices can predict risk in AF patients without a clinical history of HF is less well understood, in part because comprehensive LVDD assessments in AF are challenging (i.e., left atrial [LA] enragements frequently occur in AF patients regardless of filling pressures).…”