Treatment strategies and subsequent changes in the patient-reported quality-of-life among elderly patients with atrial fibrillation: QOL in Elderly Patients with AF

Kotaro Miura, Nobuhiro Ikemura, Takehiro Kimura, Yoshinori Katsumata, Ikuko Ueda, Kojiro Tanimoto, Takahiro Ohki, Daisuke Shinmura, Koji Negishi, Keiichi Fukuda, Seiji Takatsuki, Shun Kohsaka

Research output: Contribution to journalArticle

Abstract

Background: Rhythm-control strategy, including catheter ablation (CA) application, constitutes an integral part of atrial fibrillation (AF) management. However, elderly patients are underrepresented in clinical trials, and reports on patient-reported outcome of various rhythm-control treatments remain limited. Therefore, we aimed to investigate the application of a rhythm-control strategy for elderly patients with AF. Methods: Using a prospective, multicenter Japanese registry, we analyzed 733 patients with AF aged ≥70 years who completed the Atrial Fibrillation Effect on Quality-of-Life (AFEQT) questionnaire at baseline and 1-year visit. Improvement in patient-reported quality-of-life (QOL) was assessed according to their initial treatment strategy. Results: A total of 321 patients (43.8%) were managed with rhythm-control strategy, of which 125 (17.1%) received treatment with antiarrhythmic drugs (AADs) alone and 196 (26.7%) underwent CA. Compared with the rate-control group, the rhythm-control group was younger and less likely to have comorbid conditions but had lower baseline AFEQT-overall summary (OS) scores (71.8 [standard deviation 20.3] vs. 80.0 [standard deviation 16.1]; P < .001). After the first year, AFEQT-OS scores improved regardless of treatment strategies (ie, rate- or rhythm-control). After adjusting for confounders, CA implementation and a lower baseline AFEQT score were associated with meaningful improvement in QOL (changes in AFEQT-OS score ≥5). QOL improvement among subgroups of rhythm-control patients with AADs alone was not clinically meaningful. Conclusions: In contemporary Japanese clinical practice, rhythm-control strategy is widely implemented in elderly patients with AF, and CA use is associated with improvement in QOL in carefully selected patients.

Original languageEnglish
Pages (from-to)83-92
Number of pages10
JournalAmerican heart journal
Volume222
DOIs
Publication statusPublished - 2020 Apr

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ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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