Jansson Victoria, Bergfeldt Lennart, Schwieler Jonas, Kennebäck Göran, Rubulis Aigars, Jensen Steen M, Raatikainen Pekka, Sciaraffia Elena, Blomström-Lundqvist Carina
Department of Medical Sciences, Uppsala University, Uppsala SE 751 85, Sweden.
Department of Molecular and Clinical Medicine/Cardiology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, and Region Västra Götaland, Department of Cardiology, Sahlgrenska University Hospital, Gothenburg SE 413 45, Sweden.
Int J Cardiol Heart Vasc. 2021 May 11;34:100791. doi: 10.1016/j.ijcha.2021.100791. eCollection 2021 Jun.
To assess the relation between atrial fibrillation (AF) characteristics and health-related quality of life (QoL), and which AF characteristic had the greatest impact.
The AF characteristics burden (percentage of time in AF), duration and number of AF episodes/month were obtained from implantable cardiac monitors during the 2-month run-in period in 150 patients included in the randomized CAPTAF trial comparing early ablation and antiarrhythmic drug therapy. The QoL was measured by the General Health and Vitality dimensions of the 36-Item Short-Form Health Survey. AF characteristics were analysed continuously and in quartiles (Q1-Q4).
Greater AF burden (p = 0.003) and longer AF episodes (p = 0.013) were associated with impaired QoL (Vitality score only) in simple linear regression analyses. Greater AF burden was, however, the only AF characteristic associated with lower QoL, when adjusted for sex, type of AF, hypertension, heart rate above 110 beats per minute during AF, and beta-blocker use in multiple linear regression analyses. For every 10% increase in AF burden there was a 1.34-point decrease of Vitality score (95% confidence interval (CI) -2.67 to -0.02, p = 0.047). The Vitality score was 12 points lower (95% CI -22.73 to -1.27, p = 0.03) in patients with an AF burden > 33% (Q4) versus those with < 0.45% (Q1), but only in unadjusted analysis.
AF burden had a greater impact on QoL (Vitality), than the duration and number of AF episodes, corroborating that AF burden may be the preferred outcome measure of rhythm control in trials including relatively healthy AF populations.
评估房颤（AF）特征与健康相关生活质量（QoL）之间的关系，以及哪种AF特征影响最大。
在比较早期消融和抗心律失常药物治疗的随机CAPTAF试验中，纳入了150例患者，在2个月的导入期内从植入式心脏监测器获取AF特征负担（AF持续时间百分比）、AF发作的持续时间和每月发作次数。通过36项简短健康调查问卷的总体健康和活力维度来测量生活质量。对AF特征进行连续分析并按四分位数（Q1-Q4）分析。
在简单线性回归分析中，更高的AF负担（p = 0.003）和更长的AF发作时间（p = 0.013）与生活质量受损（仅活力评分）相关。然而，在多线性回归分析中，在对性别、AF类型、高血压、AF期间心率高于每分钟110次以及使用β受体阻滞剂进行校正后，更高的AF负担是与较低生活质量相关的唯一AF特征。AF负担每增加10%，活力评分降低1.34分（95%置信区间（CI）-2.67至-0.02，p = 0.047）。AF负担> 33%（Q4）的患者与< 0.45%（Q1）的患者相比，活力评分低12分（95% CI -22.73至-1.27，p = 0.03），但仅在未校正分析中如此。
AF负担对生活质量（活力）的影响大于AF发作的持续时间和次数，证实了在包括相对健康的AF人群的试验中，AF负担可能是节律控制的首选结局指标。
