Patient-Reported Outcomes for Quality of Life Assessment in Atrial Fibrillation: A Systematic Review of Measurement Properties.
BACKGROUND
Atrial fibrillation is a large and growing burden across all types of healthcare. Both incidence and prevalence are expected to double in the next 20 years, with huge impact on hospital admissions, costs and patient quality of life. Patient wellbeing determines the management strategy for atrial fibrillation, including the use of rhythm control therapy and the clinical success of heart rate control. Hence, evaluation of quality of life is an emerging and important part of the assessment of patients with atrial fibrillation. Although a number of questionnaires to assess quality of life in atrial fibrillation are available, a comprehensive overview of their measurement properties is lacking.


RESULTS
We performed a systematic review of the measurement properties of atrial fibrillation-specific health-related quality of life questionnaires. Methodological quality was assessed using the Consensus based Standards for selection of health Measurement Instruments (COSMIN) checklist, with measurement properties rated for quality against optimal criteria and levels of evidence. We screened 2,216 articles, of which eight articles describing five questionnaires were eligible for inclusion: Atrial Fibrillation 6 (AF6), Atrial Fibrillation Effect on QualiTy-of-Life (AFEQT), Atrial Fibrillation Quality of Life Questionnaire (AFQLQ), Atrial Fibrillation Quality of Life (AFQoL), and Quality of Life in Atrial Fibrillation (QLAF). Good reliability (internal consistency and test-retest reliability) was demonstrated for AF6, AFEQT, AFQLQ and AFQoL. Content, construct and criterion validity were positively rated only in AFEQT. Responsiveness was positively rated only in AFEQT, but with limited evidence. Overall, AFEQT showed strong positive evidence for 2 of 9 measurement properties, compared to one for AFQoL and none for the remaining questionnaires.


CONCLUSIONS
Given the low ratings for many measurement properties, no single questionnaire can be recommended, although AFEQT performed strongest. Further studies to robustly assess reliability, validity and responsiveness of AF-specific quality of life questionnaires are required. This review consolidates the current evidence for quality of life assessment in patients with atrial fibrillation and identifies priority areas for future research.
Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom.|City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom.|University Hospitals Birmingham NHS Trust, Birmingham, United Kingdom.
Dipak
http://orcid.org/0000-0002-2570-9812
D
Kotecha
Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom.
Amar
A
Ahmed
Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom.
Melanie
M
Calvert
University Hospitals Birmingham NHS Trust, Birmingham, United Kingdom.
Mauro
M
Lencioni
Department of Epidemiology and Biostatistics and the EMGO Institute of Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
Caroline B
CB
Terwee
Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom.|City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom.
Deirdre A
DA
Lane
D001281:Atrial Fibrillation; D006801:Humans; D000071066:Patient Reported Outcome Measures; D011788:Quality of Life