Health-related quality of life and healthcare costs of symptoms and cardiovascular disease events in patients with atrial fibrillation: a longitudinal analysis of 27 countries from the EURObservational Research Programme on Atrial Fibrillation general long-term registry

Abstract

Aims: We examine the effects of symptoms and cardiovascular disease (CVD) events on health-related quality of life (HRQOL) and healthcare costs in a European population with atrial fibrillation (AF).

Methods and results: In the EURObservational Research Programme on AF long-term general registry, AF patients from 250 centres in 27 European countries were enrolled and followed for 2 years. We used fixed effects models to estimate the association of symptoms and CVD events on HRQOL and annual healthcare costs. We found significant decrements in HRQOL in AF patients in whom ST-segment elevation myocardial infarction (STEMI) [-0.075 (95% confidence interval -0.144, -0.006)], angina or non-ST-elevation myocardial infarction (NSTEMI) [-0.037 (-0.071, -0.003)], new-onset/worsening heart failure [-0.064 (-0.088, -0.039)], bleeding events [-0.031 (-0.059, -0.003)], thromboembolic events [-0.071 (-0.115, -0.027)], mild symptoms [0.037 (-0.048, -0.026)], or severe/disabling symptoms [-0.090 (-0.108, -0.072)] occurred during the follow-up. During follow-up, annual healthcare costs were associated with an increase of €11 718 (€8497, €14 939) in patients with STEMI, €5823 (€4757, €6889) in patients with angina/NSTEMI, €3689 (€3219, €4158) in patients with new-onset or worsening heart failure, €3792 (€3315, €4270) in patients with bleeding events, and €3182 (€2483, €3881) in patients with thromboembolic events, compared with AF patients without these events. Healthcare costs were primarily driven by inpatient costs. There were no significant differences in HRQOL or healthcare resource use between EU regions or by sex.

Conclusion: Symptoms and CVD events are associated with a high burden on AF patients and healthcare systems throughout Europe.

Keywords: Atrial fibrillation; Health-related quality of life; Healthcare costs.

Graphical Abstract

Figure 1

Marginal effects (95% CI) of symptoms and CVD events on HRQOL and healthcare costs (€) of women relative to men. Symptoms measured using EHRA classification score. FE models with interaction terms for symptoms and CVD events with biological sex. Models adjusted for unknown time-invariant confounders and for the following observed time-variant confounders: clinical type of AF, age, medications used before each visit, and time period. Men are the reference category. AF, atrial fibrillation; CI, confidence interval; CVD, cardiovascular disease; EHRA, European Heart Rhythm Association; FE, fixed effects; HRQOL, health-related quality of life; NSTEMI, non-ST-elevation myocardial infarction; STEMI, ST-segment elevation myocardial infarction.

Figure 2

Marginal effects (95% CI) of symptoms and CVD events on HRQOL and healthcare costs (€) by region. Acute coronary syndromes includes Angina/NSTEMI and STEMI (STEMI was not estimated in Northern EU due to few events). Symptoms measured using EHRA classification score. FE models with interaction terms symptoms and CVD events with region. Models adjusted for unknown time-invariant confounders and for the following observed time-variant confounders: clinical type of AF, age, medications used before each visit, and time period. Western EU is the reference category. Northern EU countries: Denmark, Estonia, Latvia, Norway, and the UK; Western EU countries: Belgium, France, Germany, the Netherlands, and Switzerland; Eastern EU countries: Bulgaria, Czech Republic, Georgia, Kazakhstan, Kyrgyzstan, Poland, Romania, and Russia; Southern EU countries: Albania, North Macedonia, Italy, Malta, Montenegro, Portugal, Serbia, Spain, and Turkey. AF, atrial fibrillation; CI, confidence interval; CVD, cardiovascular disease; EHRA, European Heart Rhythm Association; FE, fixed effects; HRQOL, health-related quality of life; NSTEMI, non-ST-elevation myocardial infarction; STEMI, ST-segment elevation myocardial infarction.