与心房颤动患者健康相关生活质量大幅改善相关的因素：ORBIT-AF 研究结果。
Factors Associated With Large Improvements in Health-Related Quality of Life in Patients With Atrial Fibrillation: Results From ORBIT-AF.
机构信息
Division of Cardiovascular Medicine, University of Utah Health Sciences Center, Salt Lake City, (B.A.S.).
Duke Clinical Research Institute, Durham, NC (D.N.H., K.P., E.D.P., J.P.P.).
出版信息
Circ Arrhythm Electrophysiol. 2020 May;13(5):e007775. doi: 10.1161/CIRCEP.119.007775. Epub 2020 Apr 16.
BACKGROUND
Atrial fibrillation (AF) adversely impacts health-related quality of life (hrQoL). While some patients demonstrate improvements in hrQoL, the factors associated with large improvements in hrQoL are not well described.
METHODS
We assessed factors associated with a 1-year increase in the Atrial Fibrillation Effect on Quality-of-Life score of 1 SD (≥18 points; 3× clinically important difference), among outpatients in the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation I registry.
RESULTS
Overall, 28% (181/636) of patients had such a hrQoL improvement. Compared with patients not showing large hrQoL improvement, they were of similar age (median 73 versus 74, =0.3), equally likely to be female (44% versus 48%, =0.3), but more likely to have newly diagnosed AF at baseline (18% versus 8%; =0.0004), prior antiarrhythmic drug use (52% versus 40%, =0.005), baseline antiarrhythmic drug use (34.8% versus 26.8%, =0.045), and more likely to undergo AF-related procedures during follow-up (AF ablation: 6.6% versus 2.0%, =0.003; cardioversion: 12.2% versus 5.9%, =0.008). In multivariable analysis, a history of alcohol abuse (adjusted OR, 2.41; =0.01) and increased baseline diastolic blood pressure (adjusted OR, 1.23 per 10-point increase and >65 mm Hg; =0.04) were associated with large improvements in hrQoL at 1 year, whereas patients with prior stroke/transient ischemic attack, chronic obstructive pulmonary disease, and peripheral arterial disease were less likely to improve (<0.05 for each).
CONCLUSIONS
In this national registry of patients with AF, potentially treatable AF risk factors are associated with large hrQoL improvement, whereas less reversible conditions appeared negatively associated with hrQoL improvement. Understanding which patients are most likely to have large hrQoL improvement may facilitate targeting interventions for high-value care that optimizes patient-reported outcomes in AF. Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01165710.
背景
心房颤动（AF）会对健康相关生活质量（hrQoL）产生负面影响。虽然有些患者的 hrQoL 有所改善，但与 hrQoL 大幅改善相关的因素尚未得到很好的描述。
方法
我们评估了 Outcomes Registry for Better Informed Treatment of Atrial Fibrillation I 注册中心门诊患者中，在 1 年内 Atrial Fibrillation Effect on Quality-of-Life 评分增加 1 个标准差（≥18 分；3×临床重要差异）的相关因素。
结果
总体而言，28%（181/636）的患者 hrQoL 得到了改善。与没有明显的 hrQoL 改善的患者相比，他们的年龄相似（中位数 73 岁与 74 岁，=0.3），女性比例相近（44%与 48%，=0.3），但基线时新发 AF 的比例更高（18%与 8%，=0.0004），使用抗心律失常药物的比例更高（52%与 40%，=0.005），在随访期间更有可能接受 AF 相关治疗（AF 消融术：6.6%与 2.0%，=0.003；电复律：12.2%与 5.9%，=0.008）。多变量分析显示，酒精滥用史（调整后的 OR，2.41；=0.01）和基线舒张压升高（调整后的 OR，每增加 10 个点和>65mmHg 分别为 1.23；=0.04）与 1 年后的 hrQoL 大幅改善相关，而既往有卒中/短暂性脑缺血发作、慢性阻塞性肺疾病和外周动脉疾病的患者改善的可能性较小（每例<0.05）。
结论
在这项 AF 患者的全国性注册研究中，潜在可治疗的 AF 危险因素与 hrQoL 的大幅改善相关，而不太可逆的情况与 hrQoL 的改善呈负相关。了解哪些患者最有可能获得较大的 hrQoL 改善，可能有助于针对那些能够优化 AF 患者报告结局的高价值治疗进行干预。
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