title: Quality of life and functional capacity in patients with atrial fibrillation and congestive heart failure.
abstract: OBJECTIVE
  This study sought to assess the impact of rhythm- versus rate-control treatment strategies and of underlying rhythm on quality of life and functional capacity in patients with atrial fibrillation (AF) and congestive heart failure (CHF).
  
  
  BACKGROUND
  Although intention-to-treat and efficacy analyses have demonstrated similar cardiovascular outcomes in patients with AF and CHF randomized to rhythm or rate control, effects on quality of life remain to be determined.
  
  
  METHODS
  The AF-CHF (Atrial Fibrillation and Congestive Heart Failure) trial randomized 1,376 patients to rhythm- or rate-control strategies. For this pre-specified substudy, Medical Outcomes Short Form-36 questionnaires were administered at baseline and 4 months. Six-min walk tests were conducted at baseline, 3 weeks, 4 months, and 1 year.
  
  
  RESULTS
  Quality of life improved across all domains to a similar extent with rhythm and rate control. However, a higher proportion of time spent in sinus rhythm was associated with a modestly greater improvement in quality of life scores. Six-min walk distance (p = 0.2328) and New York Heart Association functional class (p = 0.1712) improved to a similar degree with rhythm and rate control. A higher proportion of time spent in sinus rhythm was associated with a greater improvement in New York Heart Association functional class (p < 0.0001) but not in 6-min walk distance (p = 0.1308).
  
  
  CONCLUSIONS
  Improvements in quality of life and functional capacity were similar in patients with AF and CHF randomized to rhythm- versus rate-control strategies. By contrast, sinus rhythm was associated with beneficial effects on New York Heart Association functional class and modest gains in quality of life. (Atrial Fibrillation and Congestive Heart Failure [AF-CHF]; NCT88597077).
authors.affiliation: Montreal Heart Institute and Montreal Heart Institute Coordinating Center, Université de Montréal, Montreal, Quebec, Canada.
authors.forename: Irina
authors.initials: I
authors.lastname: Suman-Horduna
authors.affiliation: Montreal Heart Institute and Montreal Heart Institute Coordinating Center, Université de Montréal, Montreal, Quebec, Canada.
authors.forename: Denis
authors.initials: D
authors.lastname: Roy
authors.affiliation: Montreal Heart Institute and Montreal Heart Institute Coordinating Center, Université de Montréal, Montreal, Quebec, Canada; Department of Psychiatry, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.
authors.forename: Nancy
authors.initials: N
authors.lastname: Frasure-Smith
authors.affiliation: Montreal Heart Institute and Montreal Heart Institute Coordinating Center, Université de Montréal, Montreal, Quebec, Canada.
authors.forename: Mario
authors.initials: M
authors.lastname: Talajic
authors.affiliation: Department of Psychiatry, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.
authors.forename: François
authors.initials: F
authors.lastname: Lespérance
authors.affiliation: Montreal Heart Institute and Montreal Heart Institute Coordinating Center, Université de Montréal, Montreal, Quebec, Canada.
authors.forename: Lucie
authors.initials: L
authors.lastname: Blondeau
authors.affiliation: Department of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Paul
authors.initials: P
authors.lastname: Dorian
authors.affiliation: Montreal Heart Institute and Montreal Heart Institute Coordinating Center, Université de Montréal, Montreal, Quebec, Canada. Electronic address: paul.khairy@umontreal.ca.
authors.forename: Paul
authors.initials: P
authors.lastname: Khairy
mesh_terms: D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000209:etiology / Q000503:physiopathology / Q000523:psychology / Q000628:therapy; D004554:Electric Countershock / Q000379:methods*; D017079:Exercise Tolerance / Q000187:drug effects*; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000628:therapy; D006334:Heart Function Tests / Q000187:drug effects / Q000379:methods / Q000706:statistics & numerical data; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D063305:Organ Dysfunction Scores; D010809:Physical Fitness / Q000523:psychology*; D011788:Quality of Life; D012720:Severity of Illness Index; D018434:Sickness Impact Profile; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents