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Multicenter Study
. 2025 Jan;15(1):e70248.
doi: 10.1002/brb3.70248.

The Role of Atrial Fibrillation and Oral Anticoagulation Status in Health-Related Quality of Life 12 Months After Ischemic Stroke or TIA

Manuel C Olma  1 , Lena Steindorf-Sabath  1 , Serdar Tütüncü  1 , Claudia Kunze  1 , Cornelia Fiessler  2 , Paulus Kirchhof  3   4   5 , Joanna Dietzel  6 , Johannes Schurig  1 , Patrick Oschmann  7 , Ludwig Niehaus  8 , Christian Urbanek  9 , Götz Thomalla  10 , Darius G Nabavi  11 , Joachim Röther  12 , Ulrich Laufs  13 , Roland Veltkamp  14   15 , Peter U Heuschmann  2   16 , Karl Georg Haeusler  17 , Matthias Endres  1   18   19   20   21   22 ; MonDAFIS Investigators
Affiliations
Multicenter Study

The Role of Atrial Fibrillation and Oral Anticoagulation Status in Health-Related Quality of Life 12 Months After Ischemic Stroke or TIA

Manuel C Olma et al. Brain Behav. 2025 Jan.

Abstract

Aims: Atrial fibrillation (AF) accounts for about 20% of all ischemic strokes worldwide. It is known that AF impairs health-related quality of life (HRQOL) in the general population, but data on HRQOL in stroke patients with newly diagnosed AF are sparse.

Methods: Post hoc analysis of the prospective, investigator-initiated, multicenter MonDAFIS study (NCT02204267) to analyze whether AF-related oral anticoagulation (OAC), and/or AF-symptom severity are associated with HRQOL after ischemic stroke or transient ischemic attack (TIA). HRQOL was measured using the EQ-5D-3L-questionnaire (including EQ-index/EQ-VAS) at baseline and after 12 months using multivariable linear mixed models. AF symptom severity was assessed using the European Heart Rhythm Association classification and symptom severity score (EHRA score) categorizing patients with no/mild/severe/disabling AF-related symptoms.

Results: A first episode of AF was detected in 261/2927 (8.9%) patients within 12 months after the index stroke and 227/2920 (7.8%) patients had AF and were anticoagulated at 12 months. HRQOL (measured by EQ-index, n = 2495 patients) was higher in AF patients on OAC compared to AF patients without OAC at 12 months after stroke (mean difference: MD: -16.8, 95% CI: 5.6 to 28.0), and similar in AF patients under OAC compared with patients without AF (MD: 2.0, 95% CI: -2.2 to 6.3). AF-related symptoms were negatively associated with HRQOL (measured by EQ-index) indicating that stroke patients with AF-related symptoms had a lower HRQOL compared to asymptomatic AF patients (mild vs. asymptomatic: MD: -9.0, 95% CI: -17.7 to -0.3; severe/disabling vs. asymptomatic: MD: -19.1, 95% CI: -34.7 to -3.4).

Discussion: Stroke patients with newly diagnosed AF are at risk of lower quality of life at 12 months, depending on OAC status and AF symptom severity.

Keywords: atrial fibrillation; ischemic stroke; oral anticoagulation; quality of life; transient ischemic attack.

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Conflict of interest statement

KGH reports speaker's honoraria, consulting fees or study grants from Abbott, Alexion, Amarin, AstraZeneca, Bayer Healthcare, Sanofi, Boehringer Ingelheim, Daiichi Sankyo, Novartis, Pfizer, Bristol‐Myers Squibb, Biotronik, Medtronic, Portola, Premier Research, W.L. Gore and Associates, SUN Pharma, and Edwards Lifesciences.

PK receives research support for basic, translational, and clinical research projects from European Union, British Heart Foundation, Leducq Foundation, Medical Research Council (UK), and German Centre for Cardiovascular Research, from several drug and device companies active in atrial fibrillation, and has received honoraria from several such companies in the past. PK is listed as inventor on two patents held by University of Birmingham (Atrial Fibrillation Therapy WO 2015140571, Markers for Atrial Fibrillation WO 2016012783).

GT has received speaker's honoraria or consulting fees from Acandis, Bayer Healthcare, Boehringer Ingelheim, Covidien, Bristol‐Myers‐Squibb, Portola, Stryker, and Pfizer.

DGN has received speaker's honoraria and consulting fees from AstraZeneca, Bayer, Boehringer Ingelheim, Bristol‐Myers‐Squibb, Daiichi Sankyo, Novartis, and Pfizer.

JR has received speaker's honoraria and consulting fees from Bayer, Boehringer Ingelheim, Bristol‐Myers‐Squibb, Pfizer, Daiichi Sankyo, Alexion, and Astra Zeneca.

UL reports honoraria/reimbursements for lectures, participation in studies, scientific cooperations (with Saarland University), consulting, travel, support (of colleagues) or support of scientific meetings by Amgen, Bayer, Boehringer‐Ingelheim, Daiichi‐Sankyo, MSD, Sanofi, Servier outside the submitted work. RV reports grants, personal fees and other from Bayer, grants from Boehringer, grants and personal fees from BMS, grants from Daiichi Sankyo, grants from Medtronic, personal fees from Javelin, grants from Biogen, grants and personal fees from Pfizer, personal fees from Abbott, personal fees from Astra Zeneca, other from Novartis, outside the submitted work.

RV is an investigator of Imperial BRC and partially funded by the European Union's Horizon 2020 research and innovation programme under grant agreement No. 754517 (PRESTIGE‐AF).

PUH reports grants from Charité—Universitätsmedizin Berlin during study conduct (within MonDAFIS for biometry; member scientific board) and research grants from German Ministry of Research and Education, German Research Foundation, Bavarian State (ministry for science and the arts) (within STAAB COVID‐19), European Union, Charité—Universitätsmedizin Berlin, Berlin Chamber of Physicians, German Parkinson Society, University Hospital Würzburg, Robert Koch Institute, German Heart Foundation, Federal Joint Committee (G‐BA) within the Innovationsfonds, University Hospital Heidelberg (within RASUNOA‐prime; supported by an unrestricted research grant to the University Hospital Heidelberg from Bayer, BMS, Boehringer‐Ingelheim, Daiichi Sankyo), University Göttingen (within FIND‐AF randomized; supported by an unrestricted research grant to the University Göttingen from Boehringer‐Ingelheim), outside the submitted work.

ME reports grants from Bayer and fees paid to the Charité from Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol‐Myers‐Squibb, Covidien, Daiichi Sankyo, Glaxo Smith Kline, Novartis, Pfizer, and Sanofi.

PO, CU, LN, CK, ST, CF, MO, LS, JS, and JD report no conflict of interests outside the submitted work.

Figures

FIGURE 1
FIGURE 1
Trial profile of the secondary analysis of the MonDAFIS cohort; see also Haeusler et al. (2021).
FIGURE 2
FIGURE 2
Forest plot of the mean differences of the multivariable linear regressions of Tables 2, 3, and S6 and corresponding 95% confidence intervals on EQ‐Index and EQ‐VAS at 12 months (variables for multivariable adjustments are listed in Tables 2, 3, and S6). (A) Estimated marginal means are depicted for the interaction AF × OAC (EQ‐Index/EQ‐VAS: n = 2495/2492), (B) subtype of OAC in patients in patients with AF only (EQ‐Index/EQ‐VAS: n = 195/194), and (C) AF‐symptom severity in patients with AF only stratified according to the EHRA score (EQ‐Index/EQ‐VAS: n = 218/217). p Values < 0.05 were considered statistically significant.
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References

    1. Afzal, S. K. , Hasan S. S., and Babar Z. U.. 2019. “A Systematic Review of Patient‐Reported Outcomes Associated With the Use of Direct‐Acting Oral Anticoagulants.” British Journal of Clinical Pharmacology 85, no. 12: 2652–2667. - PMC - PubMed
    1. Aliot, E. , Botto G. L., Crijns H. J., and Kirchhof P.. 2014. “Quality of Life in Patients With Atrial Fibrillation: How to Assess It and How to Improve It.” Europace 16, no. 6: 787–796. - PubMed
    1. Brundage, M. , Bass B., Davidson J., Queenan J., Bezjak A., Ringash J., et al. 2011. “Patterns of reporting health‐related quality of life outcomes inrandomized clinical trials: implications for clinicians and quality of liferesearchers.” Qual Life Res 20, no. 5: 653–664. - PubMed
    1. Contreras Muruaga, M. D. M. , Vivancos J., and Reig G., et al. 2017. “Satisfaction, Quality of Life and Perception of Patients Regarding Burdens and Benefits of Vitamin K Antagonists Compared With Direct Oral Anticoagulants in Patients With Nonvalvular Atrial Fibrillation.” Journal of Comparative Effectiveness Research 6, no. 4: 303–312. - PubMed
    1. Costa, D. S. J. , Mercieca‐Bebber R., Rutherford C., Tait M. A., and King M. T. 2021. “How Is Quality of Life Defined and Assessed in Published Research?” Quality of Life Research 30, no. 8: 2109–2121. - PubMed

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