Health-related quality of life in patients with atrial fibrillation: The role of symptoms, comorbidities, and the type of atrial fibrillation

AimsThis study aimed to analyse health related quality of life (HRQoL) for patients with different atrial fibrillation (AF) types and to identify patient characteristics, symptoms and comorbidities that influence HRQoL.MethodsWe used baseline data from the Swiss Atrial Fibrillation (Swiss-AF) study, a prospective multicentre observational cohort study conducted in 13 clinical centres in Switzerland. Between April 2014 and August 2017, 2415 AF patients were recruited. Patients were included in this analysis if they had baseline HRQoL data as assessed with EQ-5D-based utilities and visual analogue scale (VAS) scores. Patient characteristics and HRQoL were described stratified by AF type. The impact of symptoms, comorbidities and socio-economic factors on HRQoL was analysed using multivariable regression analysis.ResultsBased on 2412 patients with available baseline HRQoL data, the lowest unadjusted mean HRQoL was found in patients with permanent AF regardless of whether measured with utilities (paroxysmal: 0.83, persistent: 0.84, permanent: 0.80, pConclusionsMultiple factors turned out to influence HRQoL in AF patients. After controlling for several comorbidities, the EHRA score was one of the strongest predictors independent of AF type. The results may be valuable for better patient assessment and provide a reference point for further QoL and health economic analyses in AF populations.

### 研究目的
本研究旨在分析不同类型心房颤动（atrial fibrillation, AF）患者的健康相关生存质量（health related quality of life, HRQoL），并明确影响该类患者HRQoL的患者特征、临床症状与合并症情况。
### 研究方法
本研究采用瑞士心房颤动研究（Swiss Atrial Fibrillation, Swiss-AF）的基线数据，该研究是一项在瑞士13家临床中心开展的前瞻性多中心观察性队列研究。2014年4月至2017年8月期间，研究共纳入2415例AF患者。本次分析仅纳入采用基于EQ-5D的效用值与视觉模拟评分（visual analogue scale, VAS）完成基线HRQoL评估的患者。研究按AF类型分层描述患者特征与HRQoL水平，并采用多变量回归分析探讨症状、合并症及社会经济因素对HRQoL的影响。
### 研究结果
最终纳入2412例具备完整基线HRQoL数据的患者。结果显示，无论采用效用值还是VAS评分评估，永久性AF患者的未校正平均HRQoL水平均为最低（阵发性AF：0.83，持续性AF：0.84，永久性AF：0.80，P<0.001）。
### 研究结论
多种因素均可影响AF患者的HRQoL水平。在校正多项合并症后，欧洲心律学会评分（EHRA score）是不受AF类型影响的最强预测因子之一。本研究结果可为AF患者的精细化临床评估提供参考依据，同时可为后续AF人群的生存质量研究与卫生经济学分析提供基准参照。