Health-related quality of life in patients with atrial fibrillation treated with rhythm control versus rate control: insights from a prospective international registry (Registry on Cardiac Rhythm Disorders Assessing the Control of Atrial Fibrillation: RECORD-AF).
BACKGROUND
Improving health-related quality of life (HRQoL) is an important treatment goal in the management of patients with atrial fibrillation (AF). Uncertainty exists as to whether patients' HRQoL differ when treated with medical rhythm control or rate control. We compared HRQoL between patients treated with rhythm control or rate control in a large observational registry of patients with recent-onset AF.


RESULTS
In the Registry on Cardiac Rhythm Disorders Assessing the Control of Atrial Fibrillation (RECORD-AF), 2439 patients with recent onset (<1 year) AF completed an AF-specific HRQoL questionnaire, the University of Toronto Atrial Fibrillation Severity Scale. HRQoL was assessed by the AF symptom severity score (0-35, with higher scores reflecting more severe AF-related symptoms) at baseline and 1 year. The minimal clinically important difference was defined as a change of ≥3 points. The primary analysis was based on a propensity score-adjusted longitudinal regression analysis which compared the change in AF symptom severity scores between the 2 groups. Over an average follow-up of 1 year, the AF symptom severity scores improved in both groups (rhythm control: -2.82 point [95% confidence interval, -3.22 to -2.41]; rate control: -2.11 point [95% confidence interval, -2.54 to -1.67]; P<0.01 for both groups). The magnitude of improvement was higher in the rhythm control group than the rate control group (unadjusted difference: -0.75 point; 95% confidence interval, -1.31 to -0.19; P=0.01; propensity score-adjusted difference: -0.71 point; 95% confidence interval, -1.31 to -0.11; P=0.02).


CONCLUSIONS
In this observational cohort of recent-onset AF patients, treatment with medical rhythm- or rate control over 1 year was associated with an improvement in HRQoL. The magnitude of HRQoL improvement was minimally higher in patients treated with rhythm control than rate control. However, the overall degree of improvement was not large, and its clinical significance was uncertain.
From the University Health Network (A.C.T.H.) and St. Michael's Hospital (P.D.), Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Cardiovascular Medicine, Universitätsklinikum Münster, Münster, Germany (G.B.); St. George's University of London, London, United Kingdom (A.J.C.); Maastricht University Medical Centre, Maastricht, The Netherlands (H.J.C.); Harvard School of Public Health, Boston, MA (G.M.F.); The Lankenau Institute for Medical Research, Wynnewood, PA (P.R.K.); Hôpital Européen Georges Pompidou and Université René Descartes, Paris, France (J.-Y.L.H.); Sanofi, Paris, France (L.N.-B.); St. Vincent Medical Group, Indianapolis, IN (E.N.P.); Center for Cardiac Arrhythmias of Genetic Origin-IRCCS Istituto Auxologico Italiano, Milan, Italy (P.J.S.); Department of Health, Science and Technology, Aalborg University, Aalborg, Denmark (C.T.-P.); and Christiana Care Health System, Newark, Delaware (W.S.W.). Andrew.ha@uhn.ca.
Andrew C T
AC
Ha
From the University Health Network (A.C.T.H.) and St. Michael's Hospital (P.D.), Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Cardiovascular Medicine, Universitätsklinikum Münster, Münster, Germany (G.B.); St. George's University of London, London, United Kingdom (A.J.C.); Maastricht University Medical Centre, Maastricht, The Netherlands (H.J.C.); Harvard School of Public Health, Boston, MA (G.M.F.); The Lankenau Institute for Medical Research, Wynnewood, PA (P.R.K.); Hôpital Européen Georges Pompidou and Université René Descartes, Paris, France (J.-Y.L.H.); Sanofi, Paris, France (L.N.-B.); St. Vincent Medical Group, Indianapolis, IN (E.N.P.); Center for Cardiac Arrhythmias of Genetic Origin-IRCCS Istituto Auxologico Italiano, Milan, Italy (P.J.S.); Department of Health, Science and Technology, Aalborg University, Aalborg, Denmark (C.T.-P.); and Christiana Care Health System, Newark, Delaware (W.S.W.).
Günter
G
Breithardt
From the University Health Network (A.C.T.H.) and St. Michael's Hospital (P.D.), Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Cardiovascular Medicine, Universitätsklinikum Münster, Münster, Germany (G.B.); St. George's University of London, London, United Kingdom (A.J.C.); Maastricht University Medical Centre, Maastricht, The Netherlands (H.J.C.); Harvard School of Public Health, Boston, MA (G.M.F.); The Lankenau Institute for Medical Research, Wynnewood, PA (P.R.K.); Hôpital Européen Georges Pompidou and Université René Descartes, Paris, France (J.-Y.L.H.); Sanofi, Paris, France (L.N.-B.); St. Vincent Medical Group, Indianapolis, IN (E.N.P.); Center for Cardiac Arrhythmias of Genetic Origin-IRCCS Istituto Auxologico Italiano, Milan, Italy (P.J.S.); Department of Health, Science and Technology, Aalborg University, Aalborg, Denmark (C.T.-P.); and Christiana Care Health System, Newark, Delaware (W.S.W.).
A John
AJ
Camm
From the University Health Network (A.C.T.H.) and St. Michael's Hospital (P.D.), Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Cardiovascular Medicine, Universitätsklinikum Münster, Münster, Germany (G.B.); St. George's University of London, London, United Kingdom (A.J.C.); Maastricht University Medical Centre, Maastricht, The Netherlands (H.J.C.); Harvard School of Public Health, Boston, MA (G.M.F.); The Lankenau Institute for Medical Research, Wynnewood, PA (P.R.K.); Hôpital Européen Georges Pompidou and Université René Descartes, Paris, France (J.-Y.L.H.); Sanofi, Paris, France (L.N.-B.); St. Vincent Medical Group, Indianapolis, IN (E.N.P.); Center for Cardiac Arrhythmias of Genetic Origin-IRCCS Istituto Auxologico Italiano, Milan, Italy (P.J.S.); Department of Health, Science and Technology, Aalborg University, Aalborg, Denmark (C.T.-P.); and Christiana Care Health System, Newark, Delaware (W.S.W.).
Harry J
HJ
Crijns
From the University Health Network (A.C.T.H.) and St. Michael's Hospital (P.D.), Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Cardiovascular Medicine, Universitätsklinikum Münster, Münster, Germany (G.B.); St. George's University of London, London, United Kingdom (A.J.C.); Maastricht University Medical Centre, Maastricht, The Netherlands (H.J.C.); Harvard School of Public Health, Boston, MA (G.M.F.); The Lankenau Institute for Medical Research, Wynnewood, PA (P.R.K.); Hôpital Européen Georges Pompidou and Université René Descartes, Paris, France (J.-Y.L.H.); Sanofi, Paris, France (L.N.-B.); St. Vincent Medical Group, Indianapolis, IN (E.N.P.); Center for Cardiac Arrhythmias of Genetic Origin-IRCCS Istituto Auxologico Italiano, Milan, Italy (P.J.S.); Department of Health, Science and Technology, Aalborg University, Aalborg, Denmark (C.T.-P.); and Christiana Care Health System, Newark, Delaware (W.S.W.).
Garrett M
GM
Fitzmaurice
From the University Health Network (A.C.T.H.) and St. Michael's Hospital (P.D.), Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Cardiovascular Medicine, Universitätsklinikum Münster, Münster, Germany (G.B.); St. George's University of London, London, United Kingdom (A.J.C.); Maastricht University Medical Centre, Maastricht, The Netherlands (H.J.C.); Harvard School of Public Health, Boston, MA (G.M.F.); The Lankenau Institute for Medical Research, Wynnewood, PA (P.R.K.); Hôpital Européen Georges Pompidou and Université René Descartes, Paris, France (J.-Y.L.H.); Sanofi, Paris, France (L.N.-B.); St. Vincent Medical Group, Indianapolis, IN (E.N.P.); Center for Cardiac Arrhythmias of Genetic Origin-IRCCS Istituto Auxologico Italiano, Milan, Italy (P.J.S.); Department of Health, Science and Technology, Aalborg University, Aalborg, Denmark (C.T.-P.); and Christiana Care Health System, Newark, Delaware (W.S.W.).
Peter R
PR
Kowey
From the University Health Network (A.C.T.H.) and St. Michael's Hospital (P.D.), Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Cardiovascular Medicine, Universitätsklinikum Münster, Münster, Germany (G.B.); St. George's University of London, London, United Kingdom (A.J.C.); Maastricht University Medical Centre, Maastricht, The Netherlands (H.J.C.); Harvard School of Public Health, Boston, MA (G.M.F.); The Lankenau Institute for Medical Research, Wynnewood, PA (P.R.K.); Hôpital Européen Georges Pompidou and Université René Descartes, Paris, France (J.-Y.L.H.); Sanofi, Paris, France (L.N.-B.); St. Vincent Medical Group, Indianapolis, IN (E.N.P.); Center for Cardiac Arrhythmias of Genetic Origin-IRCCS Istituto Auxologico Italiano, Milan, Italy (P.J.S.); Department of Health, Science and Technology, Aalborg University, Aalborg, Denmark (C.T.-P.); and Christiana Care Health System, Newark, Delaware (W.S.W.).
Jean-Yves
JY
Le Heuzey
From the University Health Network (A.C.T.H.) and St. Michael's Hospital (P.D.), Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Cardiovascular Medicine, Universitätsklinikum Münster, Münster, Germany (G.B.); St. George's University of London, London, United Kingdom (A.J.C.); Maastricht University Medical Centre, Maastricht, The Netherlands (H.J.C.); Harvard School of Public Health, Boston, MA (G.M.F.); The Lankenau Institute for Medical Research, Wynnewood, PA (P.R.K.); Hôpital Européen Georges Pompidou and Université René Descartes, Paris, France (J.-Y.L.H.); Sanofi, Paris, France (L.N.-B.); St. Vincent Medical Group, Indianapolis, IN (E.N.P.); Center for Cardiac Arrhythmias of Genetic Origin-IRCCS Istituto Auxologico Italiano, Milan, Italy (P.J.S.); Department of Health, Science and Technology, Aalborg University, Aalborg, Denmark (C.T.-P.); and Christiana Care Health System, Newark, Delaware (W.S.W.).
Lisa
L
Naditch-Brûlé
From the University Health Network (A.C.T.H.) and St. Michael's Hospital (P.D.), Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Cardiovascular Medicine, Universitätsklinikum Münster, Münster, Germany (G.B.); St. George's University of London, London, United Kingdom (A.J.C.); Maastricht University Medical Centre, Maastricht, The Netherlands (H.J.C.); Harvard School of Public Health, Boston, MA (G.M.F.); The Lankenau Institute for Medical Research, Wynnewood, PA (P.R.K.); Hôpital Européen Georges Pompidou and Université René Descartes, Paris, France (J.-Y.L.H.); Sanofi, Paris, France (L.N.-B.); St. Vincent Medical Group, Indianapolis, IN (E.N.P.); Center for Cardiac Arrhythmias of Genetic Origin-IRCCS Istituto Auxologico Italiano, Milan, Italy (P.J.S.); Department of Health, Science and Technology, Aalborg University, Aalborg, Denmark (C.T.-P.); and Christiana Care Health System, Newark, Delaware (W.S.W.).
Eric N
EN
Prystowsky
From the University Health Network (A.C.T.H.) and St. Michael's Hospital (P.D.), Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Cardiovascular Medicine, Universitätsklinikum Münster, Münster, Germany (G.B.); St. George's University of London, London, United Kingdom (A.J.C.); Maastricht University Medical Centre, Maastricht, The Netherlands (H.J.C.); Harvard School of Public Health, Boston, MA (G.M.F.); The Lankenau Institute for Medical Research, Wynnewood, PA (P.R.K.); Hôpital Européen Georges Pompidou and Université René Descartes, Paris, France (J.-Y.L.H.); Sanofi, Paris, France (L.N.-B.); St. Vincent Medical Group, Indianapolis, IN (E.N.P.); Center for Cardiac Arrhythmias of Genetic Origin-IRCCS Istituto Auxologico Italiano, Milan, Italy (P.J.S.); Department of Health, Science and Technology, Aalborg University, Aalborg, Denmark (C.T.-P.); and Christiana Care Health System, Newark, Delaware (W.S.W.).
Peter J
PJ
Schwartz
From the University Health Network (A.C.T.H.) and St. Michael's Hospital (P.D.), Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Cardiovascular Medicine, Universitätsklinikum Münster, Münster, Germany (G.B.); St. George's University of London, London, United Kingdom (A.J.C.); Maastricht University Medical Centre, Maastricht, The Netherlands (H.J.C.); Harvard School of Public Health, Boston, MA (G.M.F.); The Lankenau Institute for Medical Research, Wynnewood, PA (P.R.K.); Hôpital Européen Georges Pompidou and Université René Descartes, Paris, France (J.-Y.L.H.); Sanofi, Paris, France (L.N.-B.); St. Vincent Medical Group, Indianapolis, IN (E.N.P.); Center for Cardiac Arrhythmias of Genetic Origin-IRCCS Istituto Auxologico Italiano, Milan, Italy (P.J.S.); Department of Health, Science and Technology, Aalborg University, Aalborg, Denmark (C.T.-P.); and Christiana Care Health System, Newark, Delaware (W.S.W.).
Christian
C
Torp-Pedersen
From the University Health Network (A.C.T.H.) and St. Michael's Hospital (P.D.), Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Cardiovascular Medicine, Universitätsklinikum Münster, Münster, Germany (G.B.); St. George's University of London, London, United Kingdom (A.J.C.); Maastricht University Medical Centre, Maastricht, The Netherlands (H.J.C.); Harvard School of Public Health, Boston, MA (G.M.F.); The Lankenau Institute for Medical Research, Wynnewood, PA (P.R.K.); Hôpital Européen Georges Pompidou and Université René Descartes, Paris, France (J.-Y.L.H.); Sanofi, Paris, France (L.N.-B.); St. Vincent Medical Group, Indianapolis, IN (E.N.P.); Center for Cardiac Arrhythmias of Genetic Origin-IRCCS Istituto Auxologico Italiano, Milan, Italy (P.J.S.); Department of Health, Science and Technology, Aalborg University, Aalborg, Denmark (C.T.-P.); and Christiana Care Health System, Newark, Delaware (W.S.W.).
William S
WS
Weintraub
From the University Health Network (A.C.T.H.) and St. Michael's Hospital (P.D.), Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Cardiovascular Medicine, Universitätsklinikum Münster, Münster, Germany (G.B.); St. George's University of London, London, United Kingdom (A.J.C.); Maastricht University Medical Centre, Maastricht, The Netherlands (H.J.C.); Harvard School of Public Health, Boston, MA (G.M.F.); The Lankenau Institute for Medical Research, Wynnewood, PA (P.R.K.); Hôpital Européen Georges Pompidou and Université René Descartes, Paris, France (J.-Y.L.H.); Sanofi, Paris, France (L.N.-B.); St. Vincent Medical Group, Indianapolis, IN (E.N.P.); Center for Cardiac Arrhythmias of Genetic Origin-IRCCS Istituto Auxologico Italiano, Milan, Italy (P.J.S.); Department of Health, Science and Technology, Aalborg University, Aalborg, Denmark (C.T.-P.); and Christiana Care Health System, Newark, Delaware (W.S.W.).
Paul
P
Dorian
D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000503:physiopathology / Q000523:psychology*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life; D012042:Registries; D011795:Surveys and Questionnaires
D000889:Anti-Arrhythmia Agents
atrial fibrillation; quality of life