Psychosocial and cognitive multimorbidity and health-related quality of life and symptom burden in older adults with atrial fibrillation: The systematic assessment of geriatric elements in atrial fibrillation (SAGE-AF) cohort study

Abstract

Background: Depression, anxiety, and cognitive impairments occur in up to 40 % of adults with AF and are associated with poorer health-related quality of life (HRQoL) and higher symptom burden. However, it is unknown how often these impairments co-occur, or multimorbidity, and how multimorbidity effects HRQoL and symptom burden. Methods: Patients with AF age ≥65 years with a CHA 2 DS 2 VASC risk score ≥ 2 and eligible for oral anticoagulation therapy were recruited from five clinics in a prospective cohort study. Participants completed validated measures of depression (PHQ9) and anxiety (GAD7), cognitive impairment (MoCA), and HRQOL and AF symptom burden (AFEQT). Multinomial logistic regression was used. Results: Participants (N = 1244, 49 % female) were on average 76 ± 7 years; 86 % were non-Hispanic white. Approximately 35 % of participants had 1 impairment, 17 % had 2 impairments and 8% had 3 impairments; 39 % had none of the 3 impairments examined. Compared to participants with no impairments, patients with 1, 2 and 3 impairments had higher odds of poor HRQoL (adjusted OR [AOR] = 1.77, 95 % CI 1.21, 2.60; AOR = 6.64, 95 % CI 4.43, 9.96; and AOR = 7.50, 95 % CI 4.40, 12.77, respectively) and those with 2 and 3 impairments had higher odds of high symptom burden (AOR = 3.69 95 % CI 2.22, 6.13; and AOR = 5.41 95 % CI 2.85, 10.26). Conclusions: Psychosocial/cognitive multimorbidity is common among older adults with AF and is associated with poor HRQoL and high symptom burden. Clinicians might consider incorporating psychosocial and cognitive screens into routine care as this may identify a high-risk population.

Measurement of Patient Confidence in Self-Management of Atrial Fibrillation: Initial Validation of The Confidence in Atrial fibriLlation Management (CALM) Scale

“…18 This finding is particularly relevant as patients with AF are likely to have multiple co-morbidities, multiple treatment modalities, and multiple risk factors to address suggesting a high degree of management burden. 11 Previous examination of confidence in AF self-management was completed by employing an online survey of women with AF. 10 Results indicated that the most salient item of the survey emphasized, "taking active role in my health is important in how I feel."…”

“…6 Collectively, the psychological and behavioral aspects of coping with and managing AF contribute to the key outcomes of symptom reduction and quality of life. 7,8,9,10,11 Current research approaches have generally relied on quality of life measures to capture the entirety of the patient experience. For example, the Atrial Fibrillation Effect on Quality-of-life (AFEQT) questionnaire was developed to explicitly measure patients' perceptions of their symptoms, functional impairment, treatment concerns, and satisfaction with treatment.…”

Modern atrial fibrillation care: Becoming a pro at using PROs

“…The use of PROs has long been employed in assessing patient experience related to psychosocial functioning in other settings. The prevalence of anxiety and depression was recently found to be approximately 24% and 28% in AF samples 3 and previously been shown to be associated with symptom severity, QOL, and healthcare utilization 10,11 . Depression has also been associated with a stepwise, progressively adverse change in outcomes of individuals with AF, 12 highlighting the need for assessment and intervention among this population.…”

“…Similarly, younger patients, women, and those with pulmonary disease or heart failure reported increased healthcare utilization. Increased symptom scores were also associated with more ag- has been identified as the driver of QOL decrements, 3 yet recent evidence exists that physician and patient correspondence on recognition of AF symptoms may be poor. 4 Guideline-directed medical therapy can address the medical treatment aspects but may not fully acknowledge or address the patient's perspectives on AF.…”

Measurement of patient confidence in self‐management of atrial fibrillation: Initial validation of the Confidence in Atrial fibriLlation Management (CALM) Scale

“…Daily management of AF involves adherence to medical therapies (e.g., rate/rhythm control, and stroke prophylaxis), management of comorbidities, abstinence from smoking, avoiding alcohol consumption, and sustaining regular physical activity 5 . Collectively, the psychological and behavioral aspects of coping with and managing AF contribute to the key outcomes of symptom reduction and quality of life (QOL) 6–10 …”