Baseline Health Status and its Association With Subsequent Cardiovascular Events in Patients With Atrial Fibrillation.

Background: Clinical practice guidelines recommend optimizing the health status of patients with atrial fibrillation (AF) as a primary treatment goal. Whether disease-specific health status is associated with subsequent clinical events is unknown.
Objectives: The aim of this study was to investigate the association between health status and subsequent clinical events among patients with AF.
Methods: Using a prospective cohort study of patients with new-onset AF referred to 11 hospitals (n = 3,313, 68.4% men, mean age 67.8 ± 11.6 years), data were extracted from 3,296 patients (99.4%) who completed the disease-specific Atrial Fibrillation Effects on Quality-of-Life (AFEQT) questionnaire between 2012 and 2018. Factors associated with baseline AFEQT overall summary (OS) score and associations between major adverse cardiovascular or neurologic events (MACNE; a composite of all-cause death, stroke, or new-onset heart failure hospitalization) over 2 years were investigated.
Results: Overall, 517 participants (15.6%) had poor to fair health status (AFEQT OS <60), and 1,035 (31.2%) had fair to good health status (AFEQT OS 60 to <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 heart failure were associated with lower AFEQT OS scores. Of those, 226 participants (6.8%) experienced MACNE; restricted cubic spline analysis with adjustment for factors associated with baseline AFEQT score showed a nonlinear increase in the risk for MACNE with AFEQT OS score <80. The strongest associations were observed for baseline AFEQT daily activity scores (for AFEQT daily activity score of <80 vs ≥80, HR: 1.65; 95% CI: 1.21-2.25).
Conclusions: Diminished health status in patients with AF is common and is independently associated with subsequent adverse cardiovascular events.
Competing Interests: Funding Support and Author Disclosures This study was funded by a Grant-in-Aid for Scientific Research from the Japan Society for the Promotion of Science (grants 20H03915, 20J01755, and 21K16069) and by an unrestricted research grant from Bayer Yakuhin. Dr Ikemura has received an unrestricted research grant for the Department of Cardiology, Keio University School of Medicine, from Bristol Myers Squibb. Dr Kohsaka has received an unrestricted research grant to the Department of Cardiology at Keio University School of Medicine from Bayer, Novartis, and Daiichi Sankyo; and has received personal fees from Bristol Myers Squibb. Dr Kimura has received grants from Bayer Yakuhin. Dr Takatsuki has received grants and personal fees from Bayer; and has received personal fees from Daiichi Sankyo and Bristol Myers Squibb. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
(Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)