Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital, Basel, Basel Stadt, Switzerland.
Department of Internal Medicine, Cantonal Hospital Baden, Baden, Aargau, Switzerland.
Heart. 2020 Dec;106(23):1847-1852. doi: 10.1136/heartjnl-2019-316314. Epub 2020 Mar 31.
We aimed to investigate changes in atrial fibrillation (AF)-related symptoms and quality of life (QoL) over time, and their impact on prognosis.
We prospectively followed 3836 patients with known AF for a mean of 3.7 years. Information on AF-related symptoms and QoL was obtained yearly. The primary end point was a composite of stroke or systemic embolism. Main secondary end points included stroke subtypes, all-cause mortality, cardiovascular death, hospitalisation for congestive heart failure (CHF), myocardial infarction and major bleeding. We assessed associations using multivariable, time-updated Cox proportional hazards models.
Mean age was 72 years, 72% were male. Patients with AF-related symptoms (66%) were younger (70 vs 74 years, p<0.0001), more often had paroxysmal AF (56% vs 37%, p<0.0001) and had lower QoL (71 vs 72 points, p=0.009). The incidence of the primary end point was 1.05 and 1.02 per 100 person-years in patients with and without symptoms, respectively. The multivariable adjusted HR (aHR) (95% CIs) for the primary end point was 1.11 (0.77 to 1.59; p=0.56) for AF-related symptoms. AF-related symptoms were not associated with any of the secondary end points. QoL was not significantly related to the primary end point (aHR per 5-point increase 0.98 (0.94 to 1.03; p=0.37)), but was significantly related to CHF hospitalisations (0.92 (0.90 to 0.94; p<0.0001)), cardiovascular death (0.90 (0.86 to 0.95; p<0.0001)) and all-cause mortality (0.88 (0.86 to 0.90; p<0.0001)).
AF-related symptoms were not associated with adverse outcomes and should therefore not be the basis for prognostic treatment decisions. QoL was strongly associated with CHF, cardiovascular death and all-cause mortality.
我们旨在研究心房颤动（AF）相关症状和生活质量（QoL）随时间的变化及其对预后的影响。
我们前瞻性地随访了 3836 名已知 AF 的患者，平均随访时间为 3.7 年。每年收集 AF 相关症状和 QoL 的信息。主要终点是卒中或全身性栓塞的复合终点。主要次要终点包括卒中亚型、全因死亡率、心血管死亡率、充血性心力衰竭（CHF）住院、心肌梗死和大出血。我们使用多变量、时间更新的 Cox 比例风险模型评估关联。
平均年龄为 72 岁，72%为男性。有 AF 相关症状（66%）的患者年龄较小（70 岁 vs. 74 岁，p<0.0001），更常患有阵发性 AF（56% vs. 37%，p<0.0001），且 QoL 较低（71 分 vs. 72 分，p=0.009）。有症状和无症状患者的主要终点发生率分别为 1.05 和 1.02 每 100 人年。多变量调整后的 HR（95%CI）为 1.11（0.77 至 1.59；p=0.56）。AF 相关症状与任何次要终点均无关联。QoL 与主要终点无显著相关性（每增加 5 分的 HR 为 0.98（0.94 至 1.03；p=0.37）），但与 CHF 住院（0.92（0.90 至 0.94；p<0.0001））、心血管死亡（0.90（0.86 至 0.95；p<0.0001））和全因死亡率（0.88（0.86 至 0.90；p<0.0001））显著相关。
AF 相关症状与不良结局无关，因此不应作为预后治疗决策的依据。QoL 与 CHF、心血管死亡和全因死亡率密切相关。
