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Baseline Health Status and Subsequent CV Events in AF Patients
Quick Takes
- About 50% of patients with AF have substantial health status impairment, and those patients have a higher risk of future adverse CV events.
- Patients with earlier stages of AF (e.g., younger age or paroxysmal AF), female sex, and HF have more impaired disease-specific health status.
- Measuring patient-reported outcomes in patients with AF can help provide unique prognostic information.
Study Questions:
What is the effect of the association between health status and subsequent clinical events among patients with atrial fibrillation (AF)?
Methods:
This was a multicenter prospective study of patients with new-onset AF who completed the disease-specific Atrial Fibrillation Effects on Quality-of-Life (AFEQT) questionnaire. The authors investigated factors associated with baseline AFEQT-Overall Summary (OS) scores, and associations between major adverse cardiovascular or neurological events (MACNE: a composite of all-cause death, stroke, or new-onset heart failure [HF] hospitalization) over 2 years.
Results:
A total of 3,296 patients completed the AFEQT questionnaire. Among them, 517 (16%) patients had poor to fair health status (AFEQT-OS <60), and 1,035 (31%) had fair to good health status (AFEQT-OS 60-<80) at baseline. Female sex, younger age, family history of AF, higher baseline heart rate, paroxysmal AF, initial visit to the emergency department, and history of HF were associated with lower AFEQT-OS scores. During the follow-up, 226 (6.8%) participants experienced MACNE. There was a nonlinear increase in the risk of MACNE with AFEQT-OS scores <80. The strongest associations were observed for baseline AFEQT-daily activity scores.
Conclusions:
The authors conclude that diminished health status in patients with AF is common and independently associated with subsequent adverse cardiovascular events.
Perspective:
One of the more perplexing aspects of AF is how differently it can affect patients from the most highly symptomatic on one hand to utterly being unaware of anything awry. The authors of this report use the AFEQT questionnaire to assess the patients’ disease-specific health status and show the impact that health status may have on hard clinical outcomes. AFEQT explores four domains: symptoms, daily activities, treatment concerns, and treatment satisfaction. At least half of the patients had at least a modest degree of health status impairment at presentation. Patients with poorer health status, especially in the domain of daily activities, were more likely to experience MACNE, primarily driven by a higher incidence of HF hospitalization. Worse health status correlates with worse clinical outcomes among patients with AF, highlighting the potential of disease-specific health status for specific AF interventions in future research.
Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure
Keywords: Atrial Fibrillation, Health Status, Heart Failure, Quality of Life
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