title: Is health-related quality of life a predictor of hospitalization or mortality among women or men with atrial fibrillation?
abstract: BACKGROUND
  Little is known about predictors of mortality or hospitalization in women compared with men in patients with atrial fibrillation (AF). Although there are established gender differences in patients with coronary artery disease (CAD), differences have not been established in AF.
  
  
  OBJECTIVE
  The aim of this study was to examine clinical and health-related quality of life (HRQOL) predictors of mortality and 1-year hospitalization in women compared with men with AF.
  
  
  METHODS
  Limited-use data from the National Institutes of Health/National Heart, Lung, and Blood Institute Atrial Fibrillation Follow-up Investigation of Rhythm Management clinical trial provided the sample of 693 patients with AF, 262 women and 431 men. Clinical predictors examined were heart failure (HF), CAD, left ventricular ejection fraction, diabetes, stroke, and age. Predictors of HRQOL included overall HRQOL (Medical Outcomes Study Short Form-36 physical [PCS] and mental component scores) and cardiovascular HRQOL using Quality of Life Index-Cardiac Version.
  
  
  RESULTS
  Mortality did not differ (women, 11.4%; men, 14.5%; χ(2)1 = 0.437, P = .509) according to gender, with mean 3.5-year follow-up. Different variables independently predicted mortality for women and men. For women, diabetes (hazard ratio [HR], 3.415; P = .003), HF (HR, 2.346; P = .027), stroke (HR, 2.41; P = .032), and age (HR, 1.117; P = .002), and for men, CAD (HR, 1.914; P = 02), age (HR, 1.103, P = < .001), worse PCS (HR, 1.089, P = .001), and worse Quality of Life Index-Cardiac Version score (HR, 1.402, P = .025) independently predicted mortality.One-year hospitalization (women, 38.9%; men, 36.4%) did not differ by gender (χ(2)1 = 0.914, P = .339). Different variables independently predicted 1-year hospitalization-for women: diabetes (odds ratio [OR], 2.359; P = .022), worse PCS (OR, 1.070; P = .003), and rhythm control trial arm (OR, 2.111; P = .006); for men: HF (OR, 2.072; P = .007), worse PCS (OR, 1.045; P = .019), living alone (OR, 1.913; P = .036), and rhythm control trial arm (OR, 2.113; P < .001).
  
  
  CONCLUSIONS
  Only clinical status predicted mortality among women; HRQOL and clinical status predicted mortality among men. Both clinical and HRQOL variables predicted hospitalization for women and men. Increased monitoring of HRQOL and interventions designed to target the clinical and HRQOL predictors could impact mortality and hospitalization. Nursing interventions may prove effective for modifying most of the predictors of mortality and hospitalization for women and men with AF.
authors.affiliation: Deborah W. Chapa, PhD, ACNP-BC Assistant Professor, School of Nursing, George Washington University, Washington, DC. Bimbola Akintade, PhD, ACNP-BC, MBA, MHA Assistant Professor, School of Nursing, University of Maryland, Baltimore. Eleanor Schron, PhD, RN, FAAN, FSCT Director, Clinical Applications, Vision Research Program, Division of Extramural Research, National Eye Institute/National Institutes of Health, Bethesda, Maryland. Erika Friedmann, PhD Professor, School of Nursing, University of Maryland, Baltimore. Sue A. Thomas, PhD, RN, FAAN Professor, School of Nursing, University of Maryland, Baltimore.
authors.forename: Deborah W
authors.initials: DW
authors.lastname: Chapa
authors.forename: Bimbola
authors.initials: B
authors.lastname: Akintade
authors.forename: Eleanor
authors.initials: E
authors.lastname: Schron
authors.forename: Erika
authors.initials: E
authors.lastname: Friedmann
authors.forename: Sue A
authors.initials: SA
authors.lastname: Thomas
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications / Q000401:mortality* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011788:Quality of Life; D012307:Risk Factors; D012737:Sex Factors