Department of Cardiology, Maastricht University Medical Center (MUMC+) and Cardiovascular Research Institute Maastricht (CARIM), P. Debyelaan 25, 6229 HX Maastricht, the Netherlands.
Department of Learning, Informatics, Management and Ethics, Health Outcomes and Economic Evaluation Research Group, Karolinska Institutet, Tomtebodavägen 18 A, 171 77 Stockholm, Sweden.
Europace. 2018 Jun 1;20(6):929-934. doi: 10.1093/europace/eux217.
Progression of atrial fibrillation (AF) from paroxysmal to persistent forms is an active field of research. The influence of AF progression on health related quality of life (HRQoL) is currently unknown. We aimed to assess the influence of AF progression on HRQoL, and whether this association is mediated through symptoms, treatment, and major adverse events.
In the Euro Heart Survey, 967 patients were included with paroxysmal AF who filled out EuroQoL-5D at baseline and at 1 year follow-up. Those who progressed (n = 132, 13.6%) developed more problems during follow-up than those who did not, on all EuroQoL-5D domains (increase in problems on mobility 20.5% vs. 11.4%; self-care 12.9% vs. 6.2%; usual activities 23.5% vs. 14.0%; pain/discomfort 20.5% vs. 13.7%; and anxiety/depression 22.7% vs. 15.7%; all P < 0.05), leading to a decrease in utility [baseline 0.744 ± 0.26, follow-up 0.674 ± 0.36; difference -0.07 (95% CI [-0.126,-0.013], P = 0.02)]. Multivariate analysis showed that the effect of progression on utility is mediated by a large effect of adverse events [stroke (-0.27 (95% CI [-0.43,-0.11]); P = 0.001], heart failure [-0.12 (95% CI [-0.20,-0.05]); P = 0.001], malignancy (-0.31 (95% CI [-0.56,-0.05]); P = 0.02] or implantation of an implantable cardiac defibrillator [-0.12 (95% CI [-0.23,-0.02]); P = 0.03)], as well as symptomatic AF [-0.04 (95% CI [-0.08,-0.01]); P = 0.008].
AF progression is associated with a decrease in HRQoL. However, multivariate analysis revealed that AF progression itself does not have a negative effect on HRQoL, but that this effect can be attributed to a minor effect of the associated symptoms and a major effect of associated adverse events.
从阵发性到持续性的心房颤动（AF）的进展是一个活跃的研究领域。AF 进展对健康相关生活质量（HRQoL）的影响目前尚不清楚。我们旨在评估 AF 进展对 HRQoL 的影响，以及这种关联是否通过症状、治疗和主要不良事件介导。
在 Euro Heart Survey 中，967 名阵发性 AF 患者在基线和 1 年随访时填写了 EuroQoL-5D。与未进展的患者相比，进展的患者（n=132，13.6%）在随访期间出现了更多问题，所有 EuroQoL-5D 领域均如此（移动能力问题增加 20.5%对 11.4%；自我护理 12.9%对 6.2%；日常活动 23.5%对 14.0%；疼痛/不适 20.5%对 13.7%；焦虑/抑郁 22.7%对 15.7%；所有 P<0.05），导致效用降低[基线 0.744±0.26，随访 0.674±0.36；差异 -0.07（95%CI[-0.126，-0.013]），P=0.02]。多变量分析表明，进展对效用的影响是通过不良事件的大影响介导的[中风（-0.27（95%CI[-0.43，-0.11]）；P=0.001]、心力衰竭（-0.12（95%CI[-0.20，-0.05]）；P=0.001]、恶性肿瘤（-0.31（95%CI[-0.56，-0.05]）；P=0.02]或植入植入式心脏除颤器[-0.12（95%CI[-0.23，-0.02]）；P=0.03]），以及有症状的 AF[-0.04（95%CI[-0.08，-0.01]）；P=0.008]。
AF 进展与 HRQoL 下降相关。然而，多变量分析显示，AF 进展本身对 HRQoL 没有负面影响，而是这种影响可以归因于相关症状的轻微影响和相关不良事件的主要影响。
