title: Effects of pharmacologic therapy on health-related quality of life in elderly patients with atrial fibrillation: a systematic review of randomized and nonrandomized trials.
abstract: This systematic review assessed the impact of atrial fibrillation (AF) and pharmacotherapy on health-related quality of life (HRQOL) in elderly patients. Highly prevalent in the elderly, AF is associated with morbidity and symptoms affecting HRQOL. A PubMed and EMBASE search (1999-2010) was conducted using the terms atrial fibrillation, elderly, quality of life, Medicare, and Medicaid. In all, 504 articles were identified and 15 were selected (studies examining pharmacotherapy [rate or rhythm control] and HRQOL in AF patients with a mean age ≥ 65 years). Information, including study design, cohort size, and HRQOL instruments utilized, was extracted. Five observational studies, 5 randomized trials comparing rate and rhythm control, 3 randomized trials investigating pharmacologic agents, and 2 trials examining HRQOL, depression, and anxiety were identified. Elderly AF patients had reduced HRQOL versus patients in normal sinus rhythm, particularly in domains related to physical functioning. HRQOL may be particularly affected in older AF patients. Although data do not indicate whether a pharmacologic intervention or single treatment strategy-namely rate versus rhythm control-is better at improving HRQOL, either of these strategies and many pharmacologic interventions may improve HRQOL in elderly AF patients. Based on reviewed data, an algorithm is suggested to optimize HRQOL among elderly patients.
authors: Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville, Florida, USA.
authors: Carl J
authors: CJ
authors: Pepine
keywords: aged; antiarrhythmic agents; arrhythmia; atrial fibrillation; health-related quality of life
references: Am Heart J. 2005 Jan;149(1):112-20
references: 15660042
references: N Engl J Med. 2010 Apr 15;362(15):1363-73
references: 20231232
references: Kardiol Pol. 2009 May;67(5):487-93
references: 19521933
references: Am J Cardiol. 2010 Apr 15;105(8):1122-9
references: 20381664
references: J Psychosom Res. 2009 Mar;66(3):203-10
references: 19232232
references: J Interv Card Electrophysiol. 2009 Jun;25(1):3-8
references: 19160031
references: N Engl J Med. 2002 Dec 5;347(23):1834-40
references: 12466507
references: Med Care. 1992 Jun;30(6):473-83
references: 1593914
references: Am J Cardiol. 2009 Dec 1;104(11):1534-9
references: 19932788
references: J Cardiovasc Pharmacol Ther. 2001 Jan;6(1):23-9
references: 11452333
references: Res Nurs Health. 1992 Feb;15(1):29-38
references: 1579648
references: Arch Gen Psychiatry. 1961 Jun;4:561-71
references: 13688369
references: Value Health. 2006 Sep-Oct;9(5):348-56
references: 16961553
references: Am Heart J. 2006 Dec;152(6):1097-103
references: 17161061
references: Circ J. 2009 Feb;73(2):242-8
references: 19060419
references: J Am Coll Cardiol. 2011 Mar 15;57(11):e101-98
references: 21392637
references: Am J Prev Med. 2005 Dec;29(5 Suppl 1):75-80
references: 16389130
references: Int J Psychiatry Med. 2006;36(3):315-22
references: 17236698
references: Med Care. 1996 Mar;34(3):220-33
references: 8628042
references: Am J Cardiol. 1989 Sep 15;64(10):651-4
references: 2782256
references: N Engl J Med. 1982 Apr 29;306(17):1018-22
references: 7062992
references: J Chronic Dis. 1987;40 Suppl 1:55S-69S
references: 3597698
references: Am J Med. 2006 May;119(5):448.e1-19
references: 16651058
references: Circulation. 1998 Sep 8;98(10):946-52
references: 9737513
references: J Health Soc Behav. 1983 Dec;24(4):385-96
references: 6668417
references: J Nutr Health Aging. 2010 Feb;14(2):161-6
references: 20126966
references: J Am Coll Cardiol. 2004 Jan 21;43(2):241-7
references: 14736444
references: Arch Intern Med. 1987 Sep;147(9):1561-4
references: 3632164
references: Am Heart J. 2002 Jun;143(6):984-90
references: 12075253
references: J Am Coll Cardiol. 2011 Jul 26;58(5):493-501
references: 21777747
references: J Am Coll Cardiol. 2011 Jan 18;57(3):313-21
references: 21232669
references: Nat Rev Cardiol. 2010 Mar;7(3):115-6
references: 20179715
references: Circulation. 2003 Aug 12;108(6):711-6
references: 12885749
references: J Am Coll Cardiol. 2000 Oct;36(4):1303-9
references: 11028487
references: Circ J. 2006 Aug;70(8):965-70
references: 16864926
references: Circulation. 1981 Dec;64(6):1227-34
references: 7296795
references: Med Care. 1990 Nov;28(11):1056-72
references: 2250492
references: Can J Cardiol. 2011 Jan-Feb;27(1):31-7
references: 21329860
references: Postgrad Med. 1972 Dec;52(6):81-5
references: 4635613
references: JAMA. 2001 May 9;285(18):2370-5
references: 11343485
references: Am Heart J. 2002 Jun;143(6):991-1001
references: 12075254
references: Am J Cardiol. 2000 Oct 1;86(7):764-8
references: 11018197
references: Am J Cardiol. 2010 Mar 1;105(5):687-93
references: 20185018
references: Circ Arrhythm Electrophysiol. 2011 Feb;4(1):15-25
references: 21160035
references: Heart. 2009 Jun;95(11):924-30
references: 19282313
references: J Am Coll Cardiol. 2003 May 21;41(10):1690-6
references: 12767648
references: Chest. 2007 Oct;132(4):1259-64
references: 17646231
references: Circulation. 1997 Oct 7;96(7):2455-61
references: 9337224
references: Stroke. 1991 Aug;22(8):983-8
references: 1866765
references: Eur J Cardiovasc Nurs. 2004 Apr;3(1):71-6
references: 15053890
references: Am J Med. 2007 Jun;120(6):481-7
references: 17524745
references: Med Care. 1995 Apr;33(4 Suppl):AS264-79
references: 7723455
references: Epidemiology. 2003 Nov;14(6):666-72
references: 14569181
references: Lancet. 2007 Aug 18;370(9587):604-18
references: 17707756
references: J Am Coll Cardiol. 2006 Aug 15;48(4):721-30
references: 16904540
references: Med Sci Sports Exerc. 1993 May;25(5):628-42
references: 8492692
references: Am J Cardiol. 1994 Aug 1;74(3):236-41
references: 8037127
references: Circ Arrhythm Electrophysiol. 2009 Jun;2(3):218-24
references: 19808471
references: Minerva Cardioangiol. 2009 Apr;57(2):143-50
references: 19274024