Quality of Life in Patients With Atrial Fibrillation

Abstract

Atrial fibrillation (AF) is a frequent and costly health care problem. In patients with AF, the restoration and maintenance of sinus rhythm is the primary therapeutic goal. The most frequent strategy for maintaining sinus rhythm after restoration is the use of antiarrhythmic drugs. The efficacy of therapy in AF has been predominantly measured using objective criteria such as mortality and morbidity. In recent years, the importance of quality of life (QoL) as an outcome measure has been recognized. However, few studies in the literature have examined QoL in patients with AF using properly validated tools. In addition, the specific impact of antiarrhythmic drug treatment on QoL in patients with AF has not been assessed. These issues are now being addressed in several ongoing studies. This article attempts to define QoL, makes recommendations on how QoL might be assessed, reviews our current knowledge regarding QoL in patients with AF, and discusses new clinical trials currently assessing QoL in patients with AF.

Lifetime Risk for Development of Atrial Fibrillation

“…4 AF is also associated with other embolic events and reduced quality of life. 26,27 Even when AF is diagnosed and treated, the antiarrhythmic and antithrombotic medications required to prevent recurrences or for prophylaxis against embolic phenomena carry their own attendant risks. 28 -30 Recent large clinical trials (RACE 29 and AFFIRM [Atrial Fibrillation Follow-up Investigation of Rhythm Management] 30 ) suggest that strategies designed to maintain sinus rhythm do not improve survival compared with rate control and anticoagulation.…”

Atrial fibrillation and quality of life after pacemaker implantation for sick sinus syndrome: Data from the Mode Selection Trial (MOST)

“…[17][18][19] Early studies, which suggested that AF had substantial effects on QOL, akin to other chronic diseases such as coronary artery disease or HF, were often limited by small size, design, or the use of nonvalidated instruments. 17,19 Studies in highly symptomatic patients with AF undergoing atrioventricular node ablation and often subsequent pacemaker placement also reported marked improvement in QOL in these selected patient populations.…”

“…[17][18][19] Early studies, which suggested that AF had substantial effects on QOL, akin to other chronic diseases such as coronary artery disease or HF, were often limited by small size, design, or the use of nonvalidated instruments. 17,19 Studies in highly symptomatic patients with AF undergoing atrioventricular node ablation and often subsequent pacemaker placement also reported marked improvement in QOL in these selected patient populations. [20][21][22][23] However, in the older, less selected population enrolled in the AFFIRM QOL substudy, QOL was comparable between rate and rhythm control strategies and was also similar in SR versus AF, 24,25 suggesting that effects on QOL associated with AF were quite modest in an older, medically managed population.…”

Quality of Life - Exemplified through Patients Living with Atrial Fibrillation

“…In eight of these studies, we found argument for measuring QOL or health-related QOL, referring to SF-36 as the most valid and widely applied tool [27,35,46,53,54,61,75,76]. In six of the papers [4,28,33,36,46,57], QOL or health-related QOL was defined as a multidimensional concept with subjective elements which was hard to assess and use as outcome in clinical trials. Furthermore, these papers also emphasised the importance and difficulties in working with the concept.…”