Baseline Health Status and its Association With Subsequent Cardiovascular Events in Patients With Atrial Fibrillation

Nobuhiro Ikemura; John A Spertus; Dan D Nguyen; Takehiro Kimura; Yoshinori Katsumata; Zhuxuan Fu; Philip G Jones; Nozomi Niimi; Satoshi Shoji; Ikuko Ueda; Kojiro Tanimoto; Masahiro Suzuki; Keiichi Fukuda; Seiji Takatsuki; Shun Kohsaka

doi:10.1016/j.jacep.2023.05.037

Baseline Health Status and its Association With Subsequent Cardiovascular Events in Patients With Atrial Fibrillation

JACC Clin Electrophysiol. 2023 Sep;9(9):1934-1944. doi: 10.1016/j.jacep.2023.05.037. Epub 2023 Jul 26.

Authors

Affiliations

¹ Department of Cardiology, Keio University School of Medicine, Tokyo, Japan; University of Missouri's Healthcare Institute for Innovations in Quality and Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA.
² University of Missouri's Healthcare Institute for Innovations in Quality and Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA.
³ Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
⁴ Department of General Internal Medicine, National Hospital Organization Tokyo Medical Center, Tokyo, Japan.
⁵ Department of Cardiology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan.
⁶ Department of Cardiology, National Hospital Organization Saitama Hospital, Wako, Japan.
⁷ Department of Cardiology, Keio University School of Medicine, Tokyo, Japan. Electronic address: sk@keio.jp.

PMID: 37498250
DOI: 10.1016/j.jacep.2023.05.037

Abstract

Background: Clinical practice guidelines recommend optimizing the health status of patients with atrial fibrillation (AF) as a primary treatment goal. Whether disease-specific health status is associated with subsequent clinical events is unknown.

Objectives: The aim of this study was to investigate the association between health status and subsequent clinical events among patients with AF.

Methods: Using a prospective cohort study of patients with new-onset AF referred to 11 hospitals (n = 3,313, 68.4% men, mean age 67.8 ± 11.6 years), data were extracted from 3,296 patients (99.4%) who completed the disease-specific Atrial Fibrillation Effects on Quality-of-Life (AFEQT) questionnaire between 2012 and 2018. Factors associated with baseline AFEQT overall summary (OS) score and associations between major adverse cardiovascular or neurologic events (MACNE; a composite of all-cause death, stroke, or new-onset heart failure hospitalization) over 2 years were investigated.

Results: Overall, 517 participants (15.6%) had poor to fair health status (AFEQT OS <60), and 1,035 (31.2%) had fair to good health status (AFEQT OS 60 to <80) at baseline. Female sex, younger age, family history of AF, higher baseline heart rate, paroxysmal AF, initial visit to the emergency department, and history of heart failure were associated with lower AFEQT OS scores. Of those, 226 participants (6.8%) experienced MACNE; restricted cubic spline analysis with adjustment for factors associated with baseline AFEQT score showed a nonlinear increase in the risk for MACNE with AFEQT OS score <80. The strongest associations were observed for baseline AFEQT daily activity scores (for AFEQT daily activity score of <80 vs ≥80, HR: 1.65; 95% CI: 1.21-2.25).

Conclusions: Diminished health status in patients with AF is common and is independently associated with subsequent adverse cardiovascular events.

Keywords: atrial fibrillation; quality improvement; quality of life.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Atrial Fibrillation* / complications
Atrial Fibrillation* / epidemiology
Female
Health Status
Heart Failure* / complications
Heart Failure* / epidemiology
Humans
Male
Middle Aged
Prospective Studies
Quality of Life