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Background:Physician communication of lifetime risk prediction can improve patient understanding of atrial fibrillation (AF) risk and motivate lifestyle changes and preventive measures. Therefore, our objective was to assess how physicians perceive short-term and lifetime risks of atrial fibrillation (AF), using a survey.Methods:We invited American Heart Association (AHA) members to complete an online survey via email from November 2-22, 2021. Respondents were randomized to one of 32 vignettes characterized by AF risk factors (height, weight, current smoking, systolic blood pressure, diastolic blood pressure, use of antihypertensive medication, diabetes, history of heart failure, and history of myocardial infarction). Respondents were further randomized to either estimate the 5-year or lifetime AF risk on a 0-100% scale with 10% intervals (e.g., “10-19%”) or were shown the predicted 5-year or lifetime AF risk value and asked to pick the correct interpretation in a multiple-choice question.Results:Of 11,330 AHA professional members who received the emailed survey, 109 (1%) physicians responded (mean age 51 years, 33% women) (Table). Most respondents estimated the 5-year AF risk correctly (7/9, 78%) but none accurately estimated the lifetime risk (0/18, 0%). Most respondents interpreted the predicted 5-year risk correctly (21/28, 75%) but about half of respondents misinterpreted the lifetime risk (14/25, 56%).Conclusions:In a small sample of physicians, few respondents correctly estimated and interpreted the lifetime risk of AF, suggesting that physicians may not be familiar with this risk format. It may be necessary to study the frequency and manner in which physicians communicate lifetime risk of AF.

Introduction:Social determinants of health, in particular education and income, influence the incidence, management, and outcomes of cardiovascular diseases including atrial fibrillation (AF). However, data are limited on the effect of socioeconomic status on the lifetime risk of incident AF. We assessed the association of income and education with lifetime risk of AF in the Framingham Heart Study (FHS).Methods:We selected 2172 FHS participants (51% women) who were free of AF at the index age of 55 years. We assessed educational attainment (some college or more) at the last exam prior to index age and household income ($40k/50k/55k or more depending on the FHS cohort). We estimated the lifetime risk of AF as the cumulative incidence of AF, accounting for the competing risk of death, at age 95 years. We analyzed strata defined by education and household income separately, and by combining education and household income. We adjusted analyses on sex, height, weight, systolic and diastolic blood pressure, current smoking, use of antihypertensive medication, diabetes, history of myocardial infarction, and history of heart failure.Results:Over a mean follow-up of 13 years, 265 participants developed incident AF. The lifetime risk of developing AF was 32.5% (95%CI, 26.5% to 38.5%) and 32.5% (95%CI, 28.7% to 38.3%) among participants with lower and higher education attainment (p=0.98). The lifetime risk of developing AF was 32.1% (95%CI, 26.7% to 37.5%) and 31.8% (95%CI, 26.6% to 36.9%) among participants with lower and higher household income (p=0.79). There was no evidence of an interaction between education and income on lifetime risk of AF (p = 0.84). Results were similar in subgroups of women and men.Conclusions:In our community-based sample, there was no evidence of association between education or household income and lifetime risk of AF

Background:Patient-reported outcome (PRO) assessments are commonly used in clinical heart failure (HF) trials and have been shown to be valid, reliable, sensitive measures of patients’ symptoms, function and quality of life, as well as prognostic of clinical events. To be used in routine care, they also need to be interpretable to providers and patients. Patients’ perspectives on PRO collection and results communication have not been studied.Methods:We conducted a mixed methods study of 24 ambulatory adult HF patients (50% men) who completed PROs as part of care at a HF clinic. Study procedures included (1) qualitative telephone interviews and (2) quantitative surveys following interviews. We employed thematic analysis to analyze and code transcripts using an iterative coding process and descriptive statistics to analyze the survey. Qualitative findings were purposefully linked to quantitative results.Findings:Three themes in qualitative analyses were linked to the quantitative survey: 1. Utility of data: Most participants noted that PRO questionnaires were a useful tool to better understand their health if their providers discussed the results with them, and to provide additional information to help improve their treatment. Ninety-two % (22/24) of participants strongly agreed or agreed (SA/A) and 8% (2/24) were neutral that completing the questionnaires changed their care and improved their health. Ninety-six % (23/24) of participants SA/A and 4% (1/24) were neutral that completing the questionnaires would make evaluation of their well-being more accurate. 2. Length and frequency of data collection: Most participants felt that questionnaire length (13-29 questions completed in 3-8 minutes on average) and frequency of implementation (at every visit) were satisfactory. Sixty-three % (15/24) and 37% (9/24) of participants felt that maximum number of questions should be 5-15 and >15, respectively. Eighty-three % (20/24) and 17% (4/24) of participants felt that maximum time required for completion should be 5 or 10 and >10 minutes, respectively. 3. Communication with providers: Most participants noted that their providers discussed results of PRO questionnaires with them only once or not at all and participants who had this discussion with their providers felt that providers understood their responses. Sixty-two % (15/24), 21% (5/24) and 17% (4/24) of participants SA/A, were neutral and disagreed or strongly disagreed that their providers effectively discussed results of their PROs with them.Conclusions:Qualitative results provided depth and interpretability of quantitative survey results. These results indicate successful implementation and utility of PRO questionnaires in the HF clinic, while highlighting a need for more frequent discussion of PRO results between providers and patients. Further use of PROs may lead to improved cardiovascular health and prognosis in HF.

Introduction:Sociodemographic factors (SDFs) are known to influence clinical outcomes in patients treated for various diseases. To what extent SDFs affect health-related quality of life (HRQoL) in heart failure (HF) has not been fully described.Methods:HRQoL impairment was assessed in consecutive patients in a large HF clinic using patient reported outcome (PRO) instruments - the HF specific Kansas City Cardiomyopathy Questionnaire (KCCQ-12) and the generic Visual Analogue Scale (VAS); scales 0-100. We dichotomized both scales based on severity of QoL impairment: severe to very severe (0-50) and mild to moderate (51-100). The SDFs of interest were age (continuous), sex, race (white vs non-white), partnership status (partnered vs not partnered) and health insurance type (Medicare vs Medicaid vs self-pay vs commercial). We examined associations of SDFs with KCCQ-12 and VAS in univariate analyses and multivariable adjusted logistic regression models.Results:A total of 1,016 patients were included, of whom 52.3% had severe to very severe QoL limitation by KCCQ-12 and 50.6% by VAS. After adjusting for covariates including type of HF, substance abuse and a comorbidity score, health insurance was the only SDF independently associated with HRQoL. Compared to commercial insurance, patients enrolled in Medicaid (OR = 2.58; 95% CI: 1.57, 4.25) and Medicare (OR = 1.86; 95% CI: 1.31, 2.65) had higher odds of severe to very severe HF related QoL impairment as measured by KCCQ-12. Similarly, patients enrolled in Medicaid (OR = 1.72; 95% CI: 1.21, 2.44) and Medicare (OR = 1.99; 95% CI: 1.23, 3.22) had higher odds of severe to very severe general HRQoL impairment as measured by VAS.Conclusions:In a large cross-sectional sample of HF patients, health insurance type was a SDF independently associated with HRQoL. Understanding potentially modifiable factors linked to health insurance type may identify targets to improve HRQoL in HF for Medicare and Medicaid enrollees.