Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA.
Department of Internal Medicine, Saint Vincent Hospital, Worcester, Massachusetts, USA.
J Am Geriatr Soc. 2022 Oct;70(10):2805-2817. doi: 10.1111/jgs.17954. Epub 2022 Jul 6.
In managing older adults with atrial fibrillation (AF), their symptomatology impacts their well-being and may inform treatment decision-making. We examined AF symptom perception, its impact on quality of life (QoL), and its relation to treatment strategies in older adults with AF.
Data were obtained from older adults with AF enrolled in a multicenter study conducted at clinic sites in Massachusetts and Georgia between 2016 and 2018. Participants were stratified into three age groups: 65-74 (youngest-old), 75-84 (middle-old), and ≥85 (oldest). Perception of AF symptoms was assessed by participant self-report during their clinic visit and at study enrollment by the Atrial Fibrillation Effect on Quality-of-Life Questionnaire which assessed cardiac-specific and non-specific, non-cardiac AF symptoms and their impact on QoL. Treatment strategies (rate or rhythm control) utilized were ascertained from electronic medical records.
Among the 1184 participants (mean age 75 years, 48% women, 86% Non-Hispanic White), 51% were aged 65-74 years, 36% were 75-84 years, and 13% were ≥ 85 years. The most commonly reported AF symptoms were non-specific, non-cardiac symptoms (fatigue, dyspnea, lightheadedness) with similar prevalence and impact on QoL in all age groups. Cardiac-specific AF symptoms (palpitations, irregular heartbeat, pause in heart activity) were less prevalent, but most commonly reported by the youngest participants (65-74 years), who endorsed considerable impact of these symptoms on their QoL. Overall, those who reported experiencing any AF symptoms during their clinic visit were more likely to have received rhythm compared with rate control (OR: 1.56; 95% CI: 1.18-2.04) with similar findings for all age groups except those aged ≥85 years.
Our findings suggest a high prevalence of non-specific, non-cardiac symptoms among older adults with AF and that cardiac-specific AF symptoms may exert considerable impact on their QoL. The presence of any AF symptoms may drive more rhythm control in a majority of older adults.
在管理患有心房颤动（AF）的老年人时，他们的症状会影响他们的幸福感，并可能为治疗决策提供信息。我们研究了 AF 症状感知，其对生活质量（QoL）的影响以及与老年人 AF 治疗策略的关系。
数据来自于 2016 年至 2018 年期间在马萨诸塞州和佐治亚州的诊所站点进行的多中心研究中招募的患有 AF 的老年人。参与者分为三组年龄组：65-74 岁（最年轻），75-84 岁（中老年人）和≥85 岁（老年人）。在诊所就诊期间，参与者通过自我报告评估 AF 症状的感知，并在研究入组时使用心房颤动对生活质量问卷评估心脏特异性和非特异性，非心脏性 AF 症状及其对 QoL 的影响。从电子病历中确定了所使用的治疗策略（心率或节律控制）。
在 1184 名参与者中（平均年龄 75 岁，48%为女性，86%为非西班牙裔白人），51%年龄在 65-74 岁之间，36%年龄在 75-84 岁之间，13%年龄≥85 岁。最常见的报道 AF 症状是非特异性，非心脏性症状（疲劳，呼吸困难，头晕），在所有年龄组中具有相似的患病率和对 QoL 的影响。心脏特异性 AF 症状（心悸，心律不齐，心脏活动暂停）的患病率较低，但最常见于最年轻的参与者（65-74 岁）报告，他们认为这些症状对他们的 QoL 有相当大的影响。总体而言，那些在诊所就诊期间报告有任何 AF 症状的患者比接受节律控制的患者更有可能接受节律控制（OR：1.56；95%CI：1.18-2.04），除了≥85 岁的患者之外，所有年龄组均有类似的发现。
我们的研究结果表明，患有 AF 的老年人中存在较高的非特异性，非心脏性症状的患病率，并且心脏特异性 AF 症状可能对他们的 QoL 产生相当大的影响。大多数老年人中存在任何 AF 症状可能会推动更多的节律控制。
