Division of Extramural Research, National Eye Institute/NIH, Bethesda, Maryland.
J Cardiovasc Electrophysiol. 2014 Jan;25(1):23-8. doi: 10.1111/jce.12266. Epub 2013 Sep 16.
Poor health-related quality of life (QOL) is related to morbidity and mortality in coronary heart disease and ventricular arrhythmias as well as to mortality in patients with heart failure (HF) and atrial fibrillation (AF). This study examined the contributions of QOL to the prediction of 1-year hospitalization and mortality in patients with AF, independent of HF.
This study used the public use dataset from the NHLBI/NIH AFFIRM randomized clinical trial. Patients enrolled in the QOL substudy (N = 693) were randomly assigned to rate or rhythm control. QOL was assessed with the Medical Outcomes Study 36-item Short Form Health Survey (SF-36) and the Quality of Life Index-Cardiac Version (QLI-CV). Data were analyzed with logistic regression to predict 1-year hospitalization and Cox proportional hazards analysis to predict mortality.
In the first year of participation in the study 37% (n = 256) were hospitalized; mortality was 14.3% (n = 93) with mean follow-up of 3.5 years. Patients' mean age was 69.8 ± 8.2 years, were largely male (62%), and white (93%). Patient histories included 70.8% hypertension, 38.2% coronary artery disease (CAD), and 23.7% HF. History of stroke, HF, rhythm control arm, lower SF-36 mental component scores (MCS), and lower SF-36 physical component scores (PCS) predicted hospitalization (P < 0.001). Diabetes, female gender, older age, CAD, hypertension, and lower PCS predicted mortality (P < 0.001).
QOL adds meaningful information beyond traditional biomedical factors to the prediction of mortality and/or hospitalization of patients with AF. Interventions for improving QOL and helping patients adapt to AF treatments may decrease hospitalization and improve survival.
较差的健康相关生活质量（QOL）与冠心病和室性心律失常的发病率和死亡率有关，也与心力衰竭（HF）和心房颤动（AF）患者的死亡率有关。本研究考察了 QOL 对 AF 患者 1 年住院和死亡预测的贡献，HF 因素除外。
本研究使用了 NHLBI/NIH AFFIRM 随机临床试验的公共数据集。纳入 QOL 子研究的患者（N=693）被随机分配到心率或节律控制组。使用医疗结局研究 36 项简明健康调查问卷（SF-36）和生活质量指数-心脏版本（QLI-CV）评估 QOL。采用逻辑回归分析预测 1 年住院率，采用 Cox 比例风险分析预测死亡率。
在研究的第一年，37%（n=256）的患者住院；14.3%（n=93）的患者死亡，平均随访时间为 3.5 年。患者的平均年龄为 69.8±8.2 岁，主要为男性（62%）和白人（93%）。患者病史包括 70.8%的高血压、38.2%的冠心病（CAD）和 23.7%的心力衰竭。既往有卒中、HF、节律控制组、SF-36 心理成分评分（MCS）较低和 SF-36 生理成分评分（PCS）较低与住院（P<0.001）相关。糖尿病、女性、年龄较大、CAD、高血压和较低的 PCS 与死亡率相关（P<0.001）。
QOL 除了传统的生物医学因素外，还为 AF 患者的死亡率和/或住院预测提供了有意义的信息。改善 QOL 和帮助患者适应 AF 治疗的干预措施可能会降低住院率，提高生存率。
