1. Quantifying the Impact of Atrial Fibrillation on Heart Failure–Related Patient-Reported Outcomes in the Utah mEVAL Program
- Author
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Jason Bensch, Rachel Hess, Benjamin A. Steinberg, James C. Fang, Ann Lyons, Mingyuan Zhang, Peter Wohlfahrt, John A. Spertus, Alfonso Siu, T. Jared Bunch, Jonathan P. Piccini, Tom Greene, and Josef Stehlik
- Subjects
medicine.medical_specialty ,Article ,Primary outcome ,Quality of life ,Utah ,Atrial Fibrillation ,medicine ,Humans ,Sinus rhythm ,Patient Reported Outcome Measures ,Aged ,Heart Failure ,business.industry ,Stroke Volume ,Valine ,Atrial fibrillation ,Mean age ,Middle Aged ,medicine.disease ,Clinical Practice ,Kansas City Cardiomyopathy Questionnaire ,Heart failure ,Emergency medicine ,Quality of Life ,Cardiology and Cardiovascular Medicine ,business - Abstract
Atrial fibrillation (AF) frequently complicates heart failure (HF), and each is associated with lower overall health-related quality of life. We aimed to quantify the incremental burden of AF on the health-related quality of life of patients with HF in clinical practice.We used data from the Utah mEVAL program to analyze patient-reported outcomes (PROs) among patients with HF with and without AF. The primary outcome was the HF-specific Kansas City Cardiomyopathy Questionnaire, with generic PROs as secondary outcomes. Among 1707 patients with HF, 36% had AF (n = 616). Those with HF and AF were older (mean age 69 years vs 58 years, P.001), more likely to have prior stroke (29% vs 17%, P.001) and ischemic cardiomyopathy (28% vs 23%, P = .01), but had similar ejection fractions (mean 44% each, P = .6). After adjustment, and compared with HF alone, HF with AF was associated with worse Kansas City Cardiomyopathy Questionnaire scores (adjusted mean difference -3.45, 95% confidence interval [CI] -6.24 to -0.65), and worse Patient-Reported Outcomes Measurement Information System physical function scores (adjusted mean difference -1.63, 95% CI -2.59 to -0.67). The difference in visual analog scale general health was borderline (adjusted mean difference -2.01, 95% CI -4.51 to 0.49), and Patient-Reported Outcomes Measurement Information System depression scores were similar (adjusted mean difference 0.54, 95% CI -0.48 to 1.57).AF complicates nearly one-third of HF cases, and patients with HF and AF are substantially older and sicker. After adjustment, AF was independently associated with worse disease-specific and overall health-related quality of life than HF alone. Whether maintaining sinus rhythm can improve the HF-related health status of patients with HF in clinical practice should be explored further.
- Published
- 2022
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