University Heart Center Hamburg Eppendorf, Hamburg, Germany
German Center for Cardiovascular Research partner site, Hamburg/Kiel/Lübeck, Germany.
J Am Heart Assoc. 2018 May 18;7(11):e007559. doi: 10.1161/JAHA.117.007559.
Little is known about the association of atrial fibrillation symptom burden with quality of life and outcomes.
In the Prevention of Thromboembolic Events-European Registry in Atrial Fibrillation (n=6196 patients with atrial fibrillation; mean±SD age, 71.8±10.4 years; 39.7% women), we assessed European Heart Rhythm Association score symptoms and calculated correlations with the standardized health status questionnaire (EQ-5D-5L). Patients were followed up for atrial fibrillation therapies and outcomes (stroke/transient ischemic attack/arterial thromboembolism, coronary events, heart failure, and major bleeding) over 1 year. Most individuals (92%) experienced symptoms. Correlations with health status and quality of life were modest. In multivariable-adjusted regression models, the dichotomized European Heart Rhythm Association score (intermediate/frequent versus never/occasional symptoms) was associated with cardioversions (odds ratio [OR], 1.21; 95% confidence interval [CI], 1.01-1.45) and catheter ablation (OR, 1.97; 95% CI, 1.44-2.69), and inversely related with heart rate control (OR, 0.80; 95% CI, 0.70-0.92) and heart failure incidence (OR, 1.65; 95% CI, 1.16-2.34). Anxiety was inversely related with stroke/transient ischemic attack/arterial thromboembolism (OR, 0.55; 95% CI, 0.32-0.93), whereas chest pain related positively with coronary events (OR, 2.45; 95% CI, 1.42-4.22). Fatigue (OR, 1.84; 95% CI, 1.30-2.60), dyspnea (OR, 2.33; 95% CI, 1.63-3.33), and anxiety (OR, 1.72; 95% CI, 1.16-2.55) were associated with heart failure incidence. Palpitations were positively associated with cardioversion (OR, 1.32; 95% CI, 1.08-1.61) and ablation therapy (OR, 2.02; 95% CI, 1.48-2.76).
A higher symptom burden, in particular palpitations, predicted interventions to restore sinus rhythm. The score itself had limited predictive value, but its individual components were related to different and specific clinical events, and may thus be helpful to target patient management.
心房颤动症状负担与生活质量和结局的关系知之甚少。
在预防血栓栓塞事件-心房颤动的欧洲登记处（6196 例心房颤动患者；平均±标准差年龄 71.8±10.4 岁；39.7%为女性）中，我们评估了欧洲心律协会评分症状，并计算了与标准化健康状况问卷（EQ-5D-5L）的相关性。在 1 年内对患者进行了心房颤动治疗和结局（卒中/短暂性脑缺血发作/动脉血栓栓塞、冠状动脉事件、心力衰竭和主要出血）的随访。大多数患者（92%）存在症状。与健康状况和生活质量的相关性不大。在多变量调整回归模型中，二分欧洲心律协会评分（中/频繁与无/偶尔症状）与心脏复律（比值比[OR]，1.21；95%置信区间[CI]，1.01-1.45）和导管消融（OR，1.97；95%CI，1.44-2.69）相关，与心率控制呈负相关（OR，0.80；95%CI，0.70-0.92），与心力衰竭发生率呈负相关（OR，1.65；95%CI，1.16-2.34）。焦虑与卒中/短暂性脑缺血发作/动脉血栓栓塞呈负相关（OR，0.55；95%CI，0.32-0.93），而胸痛与冠状动脉事件呈正相关（OR，2.45；95%CI，1.42-4.22）。疲劳（OR，1.84；95%CI，1.30-2.60）、呼吸困难（OR，2.33；95%CI，1.63-3.33）和焦虑（OR，1.72；95%CI，1.16-2.55）与心力衰竭发生率相关。心悸与心脏复律（OR，1.32；95%CI，1.08-1.61）和消融治疗（OR，2.02；95%CI，1.48-2.76）呈正相关。
较高的症状负担，特别是心悸，预示着恢复窦性节律的干预措施。该评分本身的预测价值有限，但它的各个组成部分与不同的特定临床事件有关，因此可能有助于针对患者进行管理。
