title: Association Between Atrial Fibrillation Symptoms, Quality of Life, and Patient Outcomes: Results From the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF).
abstract: BACKGROUND
  Instruments to assess symptom burden and quality of life among patients with atrial fibrillation (AF) have not been well evaluated in community practice or associated with patient outcomes.
  
  
  RESULTS
  Using data from 10 087 AF patients in the Outcomes Registry for Better Informed Treatment of AF (ORBIT-AF), symptom severity was evaluated using the European Heart Rhythm Association (EHRA) classification system, and quality of life was assessed using the Atrial Fibrillation Effect on Quality-of-Life (AFEQT) questionnaire. The association between AF-related symptoms, quality of life, and outcomes was assessed using Cox regression. The majority of AF patients (61.8%) were symptomatic (EHRA >2) and 16.5% had severe or disabling symptoms (EHRA 3-4). EHRA symptom class was well correlated with the AFEQT score (Spearman correlation coefficient -0.39). Over 1.8 years of follow-up, AF symptoms were associated with a higher risk of hospitalization (adjusted hazard ratio for EHRA ≥2 versus EHRA 1 1.23, 95% confidence interval, 1.15-1.31) and a borderline higher risk of major bleeding. Lower quality of life was associated with a higher risk of hospitalization (adjusted hazard ratio for lowest quartile of AFEQT versus highest 1.49, 95% confidence interval, 1.2-1.84), but not other major adverse events, including death.
  
  
  CONCLUSIONS
  In a community-based study, most patients with AF were symptomatic and had impaired quality of life. Quality of life measured by the AFEQT correlated closely with symptom severity measured by the EHRA class. AF symptoms and lower quality of life were associated with higher risk of hospitalization but not mortality during follow-up.
authors.affiliation: From the Yale University School of Medicine, New Haven, CT (J.V.F.); Duke Clinical Research Institute, Durham, NC (D.N.S., L.E.T., E.D.P., J.P.P.); Division of Research, Kaiser Permanente of Northern California, Oakland, CA (A.S.G.); Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City (J.S.); Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.); Mayo Clinic Medical Center, Rochester, Minnesota (B.J.G.); Boston University Medical Center, Boston, MA (E.M.H.); Lankenau Institute for Medical Research and Jefferson Medical College, Philadelphia, PA (P.R.K.); and Stanford University School of Medicine, Stanford, CA (K.W.M.); Janssen Pharmaceuticals Inc., Bridgewater, NJ (P.C.). james.freeman@yale.edu.
authors.forename: James V
authors.initials: JV
authors.lastname: Freeman
authors.affiliation: From the Yale University School of Medicine, New Haven, CT (J.V.F.); Duke Clinical Research Institute, Durham, NC (D.N.S., L.E.T., E.D.P., J.P.P.); Division of Research, Kaiser Permanente of Northern California, Oakland, CA (A.S.G.); Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City (J.S.); Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.); Mayo Clinic Medical Center, Rochester, Minnesota (B.J.G.); Boston University Medical Center, Boston, MA (E.M.H.); Lankenau Institute for Medical Research and Jefferson Medical College, Philadelphia, PA (P.R.K.); and Stanford University School of Medicine, Stanford, CA (K.W.M.); Janssen Pharmaceuticals Inc., Bridgewater, NJ (P.C.).
authors.forename: DaJuanicia N
authors.initials: DN
authors.lastname: Simon
authors.affiliation: From the Yale University School of Medicine, New Haven, CT (J.V.F.); Duke Clinical Research Institute, Durham, NC (D.N.S., L.E.T., E.D.P., J.P.P.); Division of Research, Kaiser Permanente of Northern California, Oakland, CA (A.S.G.); Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City (J.S.); Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.); Mayo Clinic Medical Center, Rochester, Minnesota (B.J.G.); Boston University Medical Center, Boston, MA (E.M.H.); Lankenau Institute for Medical Research and Jefferson Medical College, Philadelphia, PA (P.R.K.); and Stanford University School of Medicine, Stanford, CA (K.W.M.); Janssen Pharmaceuticals Inc., Bridgewater, NJ (P.C.).
authors.forename: Alan S
authors.initials: AS
authors.lastname: Go
authors.affiliation: From the Yale University School of Medicine, New Haven, CT (J.V.F.); Duke Clinical Research Institute, Durham, NC (D.N.S., L.E.T., E.D.P., J.P.P.); Division of Research, Kaiser Permanente of Northern California, Oakland, CA (A.S.G.); Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City (J.S.); Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.); Mayo Clinic Medical Center, Rochester, Minnesota (B.J.G.); Boston University Medical Center, Boston, MA (E.M.H.); Lankenau Institute for Medical Research and Jefferson Medical College, Philadelphia, PA (P.R.K.); and Stanford University School of Medicine, Stanford, CA (K.W.M.); Janssen Pharmaceuticals Inc., Bridgewater, NJ (P.C.).
authors.forename: John
authors.initials: J
authors.lastname: Spertus
authors.affiliation: From the Yale University School of Medicine, New Haven, CT (J.V.F.); Duke Clinical Research Institute, Durham, NC (D.N.S., L.E.T., E.D.P., J.P.P.); Division of Research, Kaiser Permanente of Northern California, Oakland, CA (A.S.G.); Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City (J.S.); Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.); Mayo Clinic Medical Center, Rochester, Minnesota (B.J.G.); Boston University Medical Center, Boston, MA (E.M.H.); Lankenau Institute for Medical Research and Jefferson Medical College, Philadelphia, PA (P.R.K.); and Stanford University School of Medicine, Stanford, CA (K.W.M.); Janssen Pharmaceuticals Inc., Bridgewater, NJ (P.C.).
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.affiliation: From the Yale University School of Medicine, New Haven, CT (J.V.F.); Duke Clinical Research Institute, Durham, NC (D.N.S., L.E.T., E.D.P., J.P.P.); Division of Research, Kaiser Permanente of Northern California, Oakland, CA (A.S.G.); Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City (J.S.); Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.); Mayo Clinic Medical Center, Rochester, Minnesota (B.J.G.); Boston University Medical Center, Boston, MA (E.M.H.); Lankenau Institute for Medical Research and Jefferson Medical College, Philadelphia, PA (P.R.K.); and Stanford University School of Medicine, Stanford, CA (K.W.M.); Janssen Pharmaceuticals Inc., Bridgewater, NJ (P.C.).
authors.forename: Bernard J
authors.initials: BJ
authors.lastname: Gersh
authors.affiliation: From the Yale University School of Medicine, New Haven, CT (J.V.F.); Duke Clinical Research Institute, Durham, NC (D.N.S., L.E.T., E.D.P., J.P.P.); Division of Research, Kaiser Permanente of Northern California, Oakland, CA (A.S.G.); Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City (J.S.); Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.); Mayo Clinic Medical Center, Rochester, Minnesota (B.J.G.); Boston University Medical Center, Boston, MA (E.M.H.); Lankenau Institute for Medical Research and Jefferson Medical College, Philadelphia, PA (P.R.K.); and Stanford University School of Medicine, Stanford, CA (K.W.M.); Janssen Pharmaceuticals Inc., Bridgewater, NJ (P.C.).
authors.forename: Elaine M
authors.initials: EM
authors.lastname: Hylek
authors.affiliation: From the Yale University School of Medicine, New Haven, CT (J.V.F.); Duke Clinical Research Institute, Durham, NC (D.N.S., L.E.T., E.D.P., J.P.P.); Division of Research, Kaiser Permanente of Northern California, Oakland, CA (A.S.G.); Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City (J.S.); Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.); Mayo Clinic Medical Center, Rochester, Minnesota (B.J.G.); Boston University Medical Center, Boston, MA (E.M.H.); Lankenau Institute for Medical Research and Jefferson Medical College, Philadelphia, PA (P.R.K.); and Stanford University School of Medicine, Stanford, CA (K.W.M.); Janssen Pharmaceuticals Inc., Bridgewater, NJ (P.C.).
authors.forename: Peter R
authors.initials: PR
authors.lastname: Kowey
authors.affiliation: From the Yale University School of Medicine, New Haven, CT (J.V.F.); Duke Clinical Research Institute, Durham, NC (D.N.S., L.E.T., E.D.P., J.P.P.); Division of Research, Kaiser Permanente of Northern California, Oakland, CA (A.S.G.); Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City (J.S.); Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.); Mayo Clinic Medical Center, Rochester, Minnesota (B.J.G.); Boston University Medical Center, Boston, MA (E.M.H.); Lankenau Institute for Medical Research and Jefferson Medical College, Philadelphia, PA (P.R.K.); and Stanford University School of Medicine, Stanford, CA (K.W.M.); Janssen Pharmaceuticals Inc., Bridgewater, NJ (P.C.).
authors.forename: Kenneth W
authors.initials: KW
authors.lastname: Mahaffey
authors.affiliation: From the Yale University School of Medicine, New Haven, CT (J.V.F.); Duke Clinical Research Institute, Durham, NC (D.N.S., L.E.T., E.D.P., J.P.P.); Division of Research, Kaiser Permanente of Northern California, Oakland, CA (A.S.G.); Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City (J.S.); Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.); Mayo Clinic Medical Center, Rochester, Minnesota (B.J.G.); Boston University Medical Center, Boston, MA (E.M.H.); Lankenau Institute for Medical Research and Jefferson Medical College, Philadelphia, PA (P.R.K.); and Stanford University School of Medicine, Stanford, CA (K.W.M.); Janssen Pharmaceuticals Inc., Bridgewater, NJ (P.C.).
authors.forename: Laine E
authors.initials: LE
authors.lastname: Thomas
authors.affiliation: From the Yale University School of Medicine, New Haven, CT (J.V.F.); Duke Clinical Research Institute, Durham, NC (D.N.S., L.E.T., E.D.P., J.P.P.); Division of Research, Kaiser Permanente of Northern California, Oakland, CA (A.S.G.); Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City (J.S.); Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.); Mayo Clinic Medical Center, Rochester, Minnesota (B.J.G.); Boston University Medical Center, Boston, MA (E.M.H.); Lankenau Institute for Medical Research and Jefferson Medical College, Philadelphia, PA (P.R.K.); and Stanford University School of Medicine, Stanford, CA (K.W.M.); Janssen Pharmaceuticals Inc., Bridgewater, NJ (P.C.).
authors.forename: Paul
authors.initials: P
authors.lastname: Chang
authors.affiliation: From the Yale University School of Medicine, New Haven, CT (J.V.F.); Duke Clinical Research Institute, Durham, NC (D.N.S., L.E.T., E.D.P., J.P.P.); Division of Research, Kaiser Permanente of Northern California, Oakland, CA (A.S.G.); Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City (J.S.); Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.); Mayo Clinic Medical Center, Rochester, Minnesota (B.J.G.); Boston University Medical Center, Boston, MA (E.M.H.); Lankenau Institute for Medical Research and Jefferson Medical College, Philadelphia, PA (P.R.K.); and Stanford University School of Medicine, Stanford, CA (K.W.M.); Janssen Pharmaceuticals Inc., Bridgewater, NJ (P.C.).
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.affiliation: From the Yale University School of Medicine, New Haven, CT (J.V.F.); Duke Clinical Research Institute, Durham, NC (D.N.S., L.E.T., E.D.P., J.P.P.); Division of Research, Kaiser Permanente of Northern California, Oakland, CA (A.S.G.); Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City (J.S.); Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.); Mayo Clinic Medical Center, Rochester, Minnesota (B.J.G.); Boston University Medical Center, Boston, MA (E.M.H.); Lankenau Institute for Medical Research and Jefferson Medical College, Philadelphia, PA (P.R.K.); and Stanford University School of Medicine, Stanford, CA (K.W.M.); Janssen Pharmaceuticals Inc., Bridgewater, NJ (P.C.).
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Piccini
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D008297:Male; D010045:Outpatients / Q000523:psychology*; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life; D012042:Registries; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
keywords: atrial fibrillation; morbidity; mortality; quality of life; symptoms