Kirch W, Pittrow D, Bosch R F, Kohlhaussen A, Willich S N, Rosin L, Bonnemeier H
Institut für Klinische Pharmakologie, Medizinische Fakultät, Technische Universität, Dresden.
Dtsch Med Wochenschr. 2010 Mar;135 Suppl 2:S26-32. doi: 10.1055/s-0030-1249205. Epub 2010 Mar 10.
In daily clinical practise, there is a lack of representative and robust data on the health-related quality of life (QoL) of patients with atrial fibrillation (AF).
In the non-interventional MOVE study, 638 physicians (predominantly cardiologists) in ambulatory care (78.0% of all centres) or hospital-based (12.7%), documented prospectively and retrospectively data from 3354 consecutive patients with ECG-confirmed AF in the previous 12 months (mean age 68.9 +/- 10.1 years; 62.4% males, mean CHADS (2) score 1.9 +/- 1.3). 1136 (33.9%) had paroxysmal, 899 (26.8%) persistent and 1295 (38.6%) permanent AF.
Symptoms within the previous 4 weeks were present in 89.9% of the cases and 43.1% of the patients reported palpitations in the range from sometimes to very frequently. As treatment aim, physicians reported rate control in 64%, rhythm control in 8%, and both in 19% of the cases (not stated: 8%). In the University of Toronto Atrial Fibrillation Severity Scale (AFSS), emergency room attendance or hospitalizations for AF or associated diseases in the previous 12 months were reported in 24.2% or 30.8%, respectively. Rhythm control was associated with higher emergency room admittance or hospitalization rates, respectively. The EQ-5D index (0.94 points) was near the maximum of 1; thus this index does not appear to reflect QoL of AF patients adequately. Analyses of the Visual Analogue Scale (VAS) of the EuroQol (EQ-5D), and the assessment scale or specific questions of AFSS, respectively, indicated an intermediate QoL or disease burden, respectively. No or only small differences were documented between subgroups with different AF types, or subgroups treated according to different aims.
The great majority of AF patients had one or more recent AF symptoms, and their overall QoL was limited. In daily practise, rate control is not inferior to rhythm control in AF patients with respect to QoL.
在日常临床实践中,缺乏关于心房颤动(AF)患者健康相关生活质量(QoL)的具有代表性且可靠的数据。
在非干预性MOVE研究中,638名医生(主要是心脏病专家)在门诊护理机构(占所有中心的78.0%)或医院(占12.7%)工作,前瞻性和回顾性记录了前12个月内3354例经心电图确诊为AF的连续患者的数据(平均年龄68.9±10.1岁;男性占62.4%,平均CHADS(2)评分为1.9±1.3)。1136例(33.9%)为阵发性AF,899例(26.8%)为持续性AF,1295例(38.6%)为永久性AF。
在前4周内有症状的病例占89.9%,43.1%的患者报告有心悸,频率从偶尔到非常频繁不等。作为治疗目标,医生报告64%的病例进行心率控制,8%进行节律控制,19%两者都采用(未提及:8%)。在多伦多大学心房颤动严重程度量表(AFSS)中,分别有24.2%或30.8%的患者报告在前12个月内因AF或相关疾病到急诊室就诊或住院。节律控制分别与较高的急诊室入院率或住院率相关。EQ - 5D指数(0.94分)接近最大值1;因此该指数似乎不能充分反映AF患者的生活质量。对欧洲生活质量量表(EQ - 5D)的视觉模拟量表(VAS)以及AFSS的评估量表或特定问题的分析分别表明生活质量或疾病负担处于中等水平。不同AF类型的亚组之间或根据不同目标治疗的亚组之间未发现差异或差异很小。
绝大多数AF患者近期有一个或多个AF症状,其总体生活质量有限。在日常实践中,就生活质量而言,AF患者的心率控制并不劣于节律控制。