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

Abstract

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.

Figure 1

Unadjusted QoL summary scores for the FRACTAL population (N=963), from enrollment through 30 months. PCS= physical component summary score; MCS= mental component summary score; physlim= physical limitations scale; psylim= psychological limitations scale; fxlim= functional limitations scale; exlim= exercise limitations scale. Population norms for the SF-12 and AF Symptom checklist are indicated by dashed horizontal lines.

Figure 2

Unadjusted SF-12 summary scores, stratified by gender, from enrollment through 30 months. PCS= physical component summary score; MCS= mental component summary score.

Figure 3

Unadjusted symptom frequency and symptoms severity scores, stratified by gender, from enrollment through 30 months.