Quality of life instruments in atrial fibrillation: a systematic review of measurement properties

Abstract

Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): Medtronic Background Atrial fibrillation (AF) is the most common arrhythmia worldwide. A key objective of AF management is symptom reduction, as quality of life (QoL) is lower for patients with AF. QoL outcomes are important for evaluating AF therapies primarily indicated for symptom control, including catheter ablation. The aim of this systematic review is to identify the most frequently used QoL instruments across AF ablation studies and to critically appraise their measurement properties. Methods and results A literature mapping exercise was completed to identify the most frequently used QoL instruments in AF ablation studies published in the past five years. A systematic review was then undertaken to critically appraise the measurement properties of the identified QoL instruments: EQ-5D, SF-36, AFEQT (AF Effect on QualiTy-of-Life), AFSS (AF Severity Scale), MLHF-Q (Minnesota Living with Heart Failure Questionnaire), AFQLQ (AF Quality of Life Questionnaire), ASTA (Arrhythmia Specific questionnaire in Tachycardia and Arrhythmia), and SCL (Arrhythmia Symptom Checklist, Frequency and Severity). The systematic review was designed using the COSMIN guidelines for systematic reviews of patient-reported outcome measurements, and was focused on the measurement properties of validity, reliability, and responsiveness. A systematic search of the literature was conducted in Ovid MEDLINE, Ovid Embase, Ovid PsycINFO, EBSCO CINAHL, and Cochrane CENTRAL. A meta-analysis was not feasible due to significant heterogeneity between studies and measurement properties, therefore results were synthesized qualitatively. 17 studies and 8 instruments were identified that met the eligibility criteria. ASTA and AFEQT had the best ratings across measurement properties with both instruments having good ratings for prom development and internal consistency. However, none of the studies assessed measurement error and cross-cultural validity. Measurement properties were inconsistent across different studies appraising the same instrument. Conclusions AFEQT and ASTA had the strongest measurement properties but not all measurement properties have been assessed. Considering the large number of indeterminate and insufficient ratings, future research should focus on cross-cultural validation, measurement error, responsiveness, and interpretability.