Olma Manuel C, Steindorf-Sabath Lena, Tütüncü Serdar, Kunze Claudia, Fiessler Cornelia, Kirchhof Paulus, Dietzel Joanna, Schurig Johannes, Oschmann Patrick, Niehaus Ludwig, Urbanek Christian, Thomalla Götz, Nabavi Darius G, Röther Joachim, Laufs Ulrich, Veltkamp Roland, Heuschmann Peter U, Haeusler Karl Georg, Endres Matthias
Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Institute of Clinical Epidemiology and Biometry, Julius-Maximilians-Universität Würzburg, Würzburg, Germany.
Brain Behav. 2025 Jan;15(1):e70248. doi: 10.1002/brb3.70248.
Atrial fibrillation (AF) accounts for about 20% of all ischemic strokes worldwide. It is known that AF impairs health-related quality of life (HRQOL) in the general population, but data on HRQOL in stroke patients with newly diagnosed AF are sparse.
Post hoc analysis of the prospective, investigator-initiated, multicenter MonDAFIS study (NCT02204267) to analyze whether AF-related oral anticoagulation (OAC), and/or AF-symptom severity are associated with HRQOL after ischemic stroke or transient ischemic attack (TIA). HRQOL was measured using the EQ-5D-3L-questionnaire (including EQ-index/EQ-VAS) at baseline and after 12 months using multivariable linear mixed models. AF symptom severity was assessed using the European Heart Rhythm Association classification and symptom severity score (EHRA score) categorizing patients with no/mild/severe/disabling AF-related symptoms.
A first episode of AF was detected in 261/2927 (8.9%) patients within 12 months after the index stroke and 227/2920 (7.8%) patients had AF and were anticoagulated at 12 months. HRQOL (measured by EQ-index, n = 2495 patients) was higher in AF patients on OAC compared to AF patients without OAC at 12 months after stroke (mean difference: MD: -16.8, 95% CI: 5.6 to 28.0), and similar in AF patients under OAC compared with patients without AF (MD: 2.0, 95% CI: -2.2 to 6.3). AF-related symptoms were negatively associated with HRQOL (measured by EQ-index) indicating that stroke patients with AF-related symptoms had a lower HRQOL compared to asymptomatic AF patients (mild vs. asymptomatic: MD: -9.0, 95% CI: -17.7 to -0.3; severe/disabling vs. asymptomatic: MD: -19.1, 95% CI: -34.7 to -3.4).
Stroke patients with newly diagnosed AF are at risk of lower quality of life at 12 months, depending on OAC status and AF symptom severity.
在全球范围内，心房颤动（AF）约占所有缺血性卒中的20%。已知AF会损害普通人群的健康相关生活质量（HRQOL），但关于新诊断为AF的卒中患者的HRQOL数据却很稀少。
对前瞻性、研究者发起的多中心MonDAFIS研究（NCT02204267）进行事后分析，以分析AF相关的口服抗凝药（OAC）和/或AF症状严重程度是否与缺血性卒中或短暂性脑缺血发作（TIA）后的HRQOL相关。在基线时以及12个月后使用多变量线性混合模型，通过EQ-5D-3L问卷（包括EQ指数/EQ视觉模拟量表）测量HRQOL。使用欧洲心律协会分类和症状严重程度评分（EHRA评分）评估AF症状严重程度，将患者分为无/轻度/重度/致残性AF相关症状。
在索引卒中后12个月内，261/2927（8.9%）例患者检测到首次发作的AF，227/2920（7.8%）例患者患有AF并在12个月时接受抗凝治疗。卒中后12个月时，接受OAC治疗的AF患者的HRQOL（通过EQ指数测量，n = 2495例患者）高于未接受OAC治疗的AF患者（平均差异：MD：-16.8，95%CI：5.6至28.0），接受OAC治疗的AF患者与无AF患者的HRQOL相似（MD：2.0，95%CI：-2.2至6.3）。AF相关症状与HRQOL（通过EQ指数测量）呈负相关，表明与无症状AF患者相比，有AF相关症状的卒中患者HRQOL较低（轻度与无症状：MD：-9.0，95%CI：-17.7至-0.3；重度/致残性与无症状：MD：-19.1，95%CI：-34.7至-3.4）。
新诊断为AF的卒中患者在12个月时存在生活质量较低的风险，这取决于OAC状态和AF症状严重程度。
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