Elsevier

American Heart Journal

Volume 152, Issue 6, December 2006, Pages 1097-1103
American Heart Journal

Clinical Investigation
Electrophysiology
Influence of age, sex, and atrial fibrillation recurrence on quality of life outcomes in a population of patients with new-onset atrial fibrillation: The Fibrillation Registry Assessing Costs, Therapies, Adverse events and Lifestyle (FRACTAL) study

https://doi.org/10.1016/j.ahj.2006.08.011Get rights and content

Background

Most quality of life (QoL) data in AF have been collected from clinical trial patients. We sought to characterize symptoms and QoL in a large inception cohort of unselected patients with AF and explore the impact of age, sex, and AF clinical course on QoL measures over time.

Methods

We collected symptom and QoL data on 963 patients with new onset AF enrolled in a multicenter observational registry. Patients were primarily managed with pharmacologic therapy and cardioversion. Quality of life instruments including the Medical Outcomes Study Short Form-12, University of Toronto AF Severity Scale, and the AF Symptom Checklist were completed at baseline and repeated over 2.5 years. Time-weighted QoL summary scores over the first year were calculated for each patient. Factors associated with those summary scores were explored in multivariable analyses.

Results

Quality of life was moderately impaired at baseline, but quickly approached population norms and remained stable thereafter. After multivariable adjustment, female sex was strongly associated with higher symptom scores and lower QoL scores. Older (age >65 years) patients reported less prominent disease-specific impairment in QoL than younger patients. In part because 73% of patients appeared to maintain sinus rhythm for the first year, AF clinical course had a comparatively small impact on QoL during this timeframe.

Conclusions

Quality of life is impaired in newly diagnosed patients with AF, but improves to normal levels with standard treatments. Within the first year after diagnosis, sex, age, and comorbid conditions are more strongly associated with QoL outcomes than the clinical course of AF itself.

Section snippets

Study population

FRACTAL is an inception cohort study of patients with AF or flutter. Between May 1997 and June 2000, 1005 patients were enrolled at 17 centers in the United States and Canada after their first electrocardiographically confirmed episode. Atrial fibrillation occurring within 7 days of cardiac surgery was excluded. Patient management remained at the discretion of local practitioners. The study protocol was approved by the institutional committee on human research at each site, and patients

Results

Quality of life surveys were completed by 963 registry participants at enrollment. Baseline characteristics of this population, stratified by sex and by age older or younger than 65 years, are displayed in Table I.

The initial episode of AF either spontaneously converted to sinus rhythm or successfully treated with cardioversion in 926 (96%) patients. Atrial fibrillation was accepted as a permanent state from the outset in the other 37 patients. During the first year of follow-up, 10 more

Discussion

In this large inception cohort of newly diagnosed patients with AF, we found moderate symptom burden and reductions in both generic and disease-specific QoL at baseline, which normalized quickly after initial treatment and remained largely stable thereafter. Symptomatic recurrences of AF were relatively infrequent during early follow-up (22% at 1 year) in this population. Quality of life and symptom scores were therefore influenced less by the clinical course of AF than by comorbid illnesses

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    Financial support: FRACTAL has received financial support from Medtronic, Inc (Minneapolis, MN), and AstraZeneca (Wilmington, DE). Dr Reynolds is the recipient of grant K23HL077171 from the National Heart, Lung, and Blood Institute (NHLBI). Dr Essebag is the recipient of a Clinician Scientist Award from the Canadian Institutes of Health Research (CIHR).

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