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Benezet-Mazuecos J, Alonso P, Lozano JM, Salas J, González Lorenzo O, Rodríguez-Mañero M, Narváez I, Lozano Á, Miracle Á, Crosa J, Barrio I. Digital devices for heart rhythm monitoring in atrial fibrillation patients scheduled for elective electrical cardioversion. Med Clin (Barc) 2024:S0025-7753(24)00478-0. [PMID: 39191551 DOI: 10.1016/j.medcli.2024.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 06/28/2024] [Accepted: 07/03/2024] [Indexed: 08/29/2024]
Abstract
INTRODUCTION AND OBJECTIVES Management in recent-onset atrial fibrillation (AF) is to achieve sinus rhythm (SR) by cardioversion (CV). However, frequently SR is spontaneously restored, making scheduled admission unnecessary and causing misutilization of healthcare resources. Emerging medical technology allows accurate heart rhythm monitoring. This study evaluated this technology in these patients, preventing unnecessary admission and providing an earlier management. METHODS A multicenter study was designed including patients with AF scheduled for elective electrical CV. Patients submitted ECG recordings to a central CoreLab daily, twice a day and whenever they present symptoms, until CV (spontaneous or scheduled) and a week afterwards. Whenever a spontaneous conversion to SR was detected, investigators were contacted to confirm SR and abort admission. Patients' satisfaction was evaluated using a test for perceived utility, convenience, and accessibility. RESULTS 74 patients were enrolled (age 62±10 years). Twenty-two patients (30%) showed spontaneous conversion to SR. A total of 22 admissions and 16 transesophageal echocardiograms were prevented. Among 52 patients admitted for CV, 45 (88%) were discharged in SR. During follow-up after conversion to SR (spontaneous or electrical), recurrences of AF occurred in 24 patients (34%). At the end of the follow-up 51 patients (69%) remained in SR. The CoreLab received 93% of the expected ECG transmissions. Patient's overall satisfaction score was 9.1 over 10. CONCLUSION Digital devices for heart rhythm monitoring can optimize the management of AF patients scheduled for elective CV, preventing unnecessary admissions and providing a more rational use of healthcare resources.
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Affiliation(s)
- Juan Benezet-Mazuecos
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario La Luz, Madrid, España.
| | - Pau Alonso
- Unidad de Arritmias, Servicio de Cardiología, Hospital de Manises, Manises, Valencia, España
| | - José Miguel Lozano
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario San Cecilio, Granada, España
| | - Jefferson Salas
- Servicio de Cardiología, Hospital Sur Alcorcón, Alcorcón, Madrid, España
| | | | - Moisés Rodríguez-Mañero
- Unidad de Arritmias, Complejo Hospitalario Universitario de Santiago de Compostela (CHUS), Santiago de Compostela, A Coruña, España
| | - Irene Narváez
- Servicio de Cardiología, Hospital Quirónsalud Toledo, Toledo, España
| | - Álvaro Lozano
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario La Luz, Madrid, España
| | - Ángel Miracle
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario La Luz, Madrid, España
| | - Julián Crosa
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario La Luz, Madrid, España
| | - Isabel Barrio
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario La Luz, Madrid, España
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Hutchings HA, Lanyon KJ, Holland G, Alikhan R, Jenkins R, Laing H, Hughes A, Lobban T, Pollock K, Tod D, Lister S. Can we collect health-related quality of life information from anticoagulated atrial fibrillation participants who have recently experienced a bleed? An observational feasibility study in primary and secondary care in Wales and through a UK online forum. BMJ Open 2023; 13:e075335. [PMID: 37802619 PMCID: PMC10565208 DOI: 10.1136/bmjopen-2023-075335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 09/13/2023] [Indexed: 10/10/2023] Open
Abstract
OBJECTIVE To evaluate the feasibility of recruiting participants diagnosed with atrial fibrillation (AF) taking oral anticoagulation therapies (OATs) and recently experiencing a bleed to collect health-related quality of life (HRQoL) information. DESIGN Observational feasibility study. The study aimed to determine the feasibility of recruiting participants with minor and major bleeds, the most appropriate route for recruitment and the appropriateness of the patient-reported outcome measures (PROMs) selected for collecting HRQoL information in AF patients, and the preferred format of the surveys. SETTING Primary care, secondary care and via an online patient forum. PARTICIPANTS The study population was adult patients (≥18) with AF taking OATs who had experienced a recent major or minor bleed within the last 4 weeks. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcomes - PROMs: EuroQol 5 Dimensions-5 Levels, Perception of Anticoagulant Treatment Questionnaire, part 2 only (part 2), atrial fibrillation effect on quality of life. Secondary outcomes - Location of bleed, bleed severity, current treatment, patient perceptions of HRQoL in relation to bleeding events. RESULTS We received initial expressions of interest from 103 participants. We subsequently recruited 32 participants to the study-14 from primary care and 18 through the AF forum. No participants were recruited through secondary care. Despite 32 participants consenting, only 26 initial surveys were completed. We received follow-up surveys from 11 participants (8 primary care and 3 AF forum). COVID-19 had a major impact on the study. CONCLUSIONS Primary care was the most successful route for recruitment. Most participants recruited to the study experienced a minor bleed. Further ways to recruit in secondary care should be explored, especially to capture more serious bleeds. TRIAL REGISTRATION NUMBER The study is registered in the Clinicaltrials.gov database, NCT04921176.
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Affiliation(s)
| | - Kirsty J Lanyon
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Gail Holland
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Raza Alikhan
- Department of Haematology, University Hospital of Wales, Cardiff, UK
| | | | - Hamish Laing
- VBHC Academy, School of Management, Swansea University, Swansea, UK
| | | | | | - Kevin Pollock
- Bristol-Myers Squibb Pharmaceuticals Ltd, Uxbridge, UK
| | - Daniel Tod
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Steven Lister
- Bristol-Myers Squibb Pharmaceuticals Ltd, Uxbridge, UK
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3
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Lomper K, Ross C, Uchmanowicz I. Anxiety and Depressive Symptoms, Frailty and Quality of Life in Atrial Fibrillation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1066. [PMID: 36673821 PMCID: PMC9858928 DOI: 10.3390/ijerph20021066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/27/2022] [Accepted: 01/04/2023] [Indexed: 06/17/2023]
Abstract
Introduction: Symptoms of atrial fibrillation (AF) can significantly affect functioning in daily life and reduce patients’ quality of life (QoL). The severity and type of AF symptoms affects not only patient’s QoL, but can be a cause of the development of emotional and psychological disorders. In addition, frailty syndrome (FS) plays important role from the point of view of developing disability and dependence on others, as well as reducing QoL. Aim: To assess the symptoms of anxiety and depression, to evaluate the co-occurrence of frailty syndrome and the impact of these factors on the quality of life of patients with AF. Methods: The study used a Polish adaptation of the Arrhythmia-Specific questionnaire in Tachycardia and Arrhythmia part III (ASTA part III), the Tilburg Frailty Indicator (TFI) and the Hospital Anxiety Depression Scale (HADS). Results: Analysis showed that anxiety symptoms and depressive symptoms correlate significantly (p < 0.05) and positively with the physical (r = 0.24; p < 0.001, r = 0.29, p = 0.002, respectively), psychological (r = 0.34, p < 0.001, r = 0.49 p < 0.001, respectively) and total quality of life (r = 0.31, p = 0.001, r = 0.414; p < 0.001, respectively) ASTA III domains. A significant (p < 0.05) positive correlation was observed between the TFI total score and the physical (r = 0.34, p < 0.001), psychological (r = 0.36, p < 0.001) and overall quality of life (r = 0.38, p < 0.001) in ASTA III domains. Conclusions: Both FS and depressive and anxiety symptoms significantly affect QoL. Understanding the relationship between anxiety and depressive symptoms, FS and QoL may allow for a more targeted approach to the treatment and care of patients with AF.
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Affiliation(s)
- Katarzyna Lomper
- Department of Clinical Nursing, Medical University, K. Bartla 5, 51-616 Wroclaw, Poland
| | - Catherine Ross
- The Centre for Cardiovascular Health, School of Health and Social Care, Edinburgh Napier University, Edinburgh EH11 4BN, UK
| | - Izabella Uchmanowicz
- Department of Clinical Nursing, Medical University, K. Bartla 5, 51-616 Wroclaw, Poland
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4
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Impact of Catheter Ablation for Atrial Fibrillation on Quality of Life. J Clin Med 2022; 11:jcm11154541. [PMID: 35956155 PMCID: PMC9369868 DOI: 10.3390/jcm11154541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/29/2022] [Accepted: 08/02/2022] [Indexed: 11/17/2022] Open
Abstract
Atrial fibrillation is the most common sustained cardiac arrhythmia in adults. It is a complex arrhythmia leading to increased morbidity and mortality requiring thorough assessment and classification to guide therapy and to assess whether to pursue rate or rhythm control therapy. To obtain rhythm control, several strategies are available with different advantages and disadvantages concerning success rate and safety. Apart from antiarrhythmic drugs, catheter ablation is a well-established invasive therapy to treat atrial fibrillation. As quality of life is a very important factor to pursue rhythm control, several studies investigated on the specific impact of catheter ablation on quality of life. Catheter ablation shows a beneficial effect on quality of life in paroxysmal and persistent atrial fibrillation independent of the timepoint and strategy of catheter ablation.
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5
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Blomström-Lundqvist C, Svedung Wettervik V. Reflections on the usefulness of today's atrial fibrillation ablation procedure endpoints and patient-reported outcomes. Europace 2022; 24:ii29-ii43. [PMID: 35661867 DOI: 10.1093/europace/euab318] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 12/13/2021] [Indexed: 12/14/2022] Open
Abstract
The improvement of Patient-reported outcomes, such as health-related quality of life, is the main indication for atrial fibrillation ablation. Despite this guideline derived indication for an AF ablation procedure the current standardized primary endpoint in AF ablation trials is still rhythm-related, and primarily a 30-second long AF episode. The review presents reflections on the non-rational arguments of using rhythm related endpoints rather than Patient-reported outcomes in AF ablation procedure trials despite the mismatch between many of the rhythm related variables and symptoms. Arguments for health-related quality of life as the most optimal primary endpoint in clinical trials are presented while atrial fibrillation burden is presented as the most optimal electrical complementary endpoint, apart from being the major variable in mechanistic trials.
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6
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Farjat AE, Virdone S, Thomas LE, Kakkar AK, Pieper KS, Piccini JP. The importance of the design of observational studies in comparative effectiveness research: Lessons from the GARFIELD-AF and ORBIT-AF registries. Am Heart J 2022; 243:110-121. [PMID: 34529945 DOI: 10.1016/j.ahj.2021.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 09/07/2021] [Indexed: 12/11/2022]
Abstract
Randomized controlled trials (RCTs) are considered the gold standard for estimating the effectiveness of a treatment. However, in many instances they are impractical to conduct because of time limitations, cost restrictions, or ethical reasons. As a consequence, non-randomized observational studies have an important role in comparative effectiveness and safety research since they can address issues that would not be possible using conventional RCT methodology. Observational studies can be strategically designed to reduce the risk of potential sources of bias by emulating the design principles of an equivalent but ideal randomized trial - the target trial - that would answer the research question of interest. In this article, we review some of the necessary components of observational studies required for valid causal inference within the framework of target trial emulation, so as to avoid common methodological pitfalls of study design. We discuss the assumptions of consistency, time-zero specification, exchangeability and positivity. To illustrate these concepts in a context where existing knowledge is well-established through clinical trials, we evaluate and compare the treatment effects of vitamin K antagonists (VKA) against no VKA (No VKA) on the treatment of atrial fibrillation from two real-world observational studies, namely the GARFIELD-AF and ORBIT-AF registries. Results are compared with those of published RCTs.
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7
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Hatala R. Rhythm control in asymptomatic 'early' atrial fibrillation: birth of a new paradigm? Eur Heart J 2021; 43:1231-1233. [PMID: 34864934 DOI: 10.1093/eurheartj/ehab811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Robert Hatala
- Department of Cardiology an Angiology, National Cardiovascular Institute and Slovak Medical University, Bratislava, Slovakia
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8
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Dong Z, Du X, Hou XX, He L, Dong JZ, Ma CS. Effect of electrical cardioversion on 1-year outcomes in patients with early recurrence after catheter ablation for atrial fibrillation. Clin Cardiol 2021; 44:1128-1138. [PMID: 34101841 PMCID: PMC8364725 DOI: 10.1002/clc.23663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 05/18/2021] [Indexed: 12/15/2022] Open
Abstract
Background Atrial fibrillation (AF) recurrence is common in the 3‐month blanking‐period after catheter ablation, during which electrical cardioversion (ECV) is usually performed to restore sinus rhythm. Whether ECV can affect the clinical outcome of post‐ablation AF patients is inconsistent, however. We aimed to explore the 1‐year effect of ECV on AF recurrence and rehospitalization in patients experienced recurrence within 3‐month after AF catheter ablation. Methods Patients who experienced recurrence within 3‐month after AF catheter ablation procedure were enrolled from the China Atrial Fibrillation Registry (China‐AF). A 1:3 Propensity score matching (PSM) method was applying to adjust the confounders between patients who had been treated by ECV or not. Logistic regression models were conducted to evaluate the association of ECV with 1‐year AF recurrence and rehospitalization. Results In this study, 2961 patients experienced AF recurrence within 3‐month after the procedure, and 282 of them underwent successful ECV, 2155 patients did not undergo ECV. One‐year AF recurrence rates were 56.4% in ECV group versus 65.4% in non‐ECV group (p = .003), and were 55.9% versus 65.9%, respectively, after PSM (adjusted odds ratio [OR] 0.66; 95% confidence interval (CI): 0.49–0.88, p = .005). However, the difference of 1‐year rehospitalization rates between two groups were not statistically significant before (ECV group: 23.7% vs. non‐ECV group: 22.3%, p = .595) and after PSM (ECV group: 24.4% vs. non‐ECV group: 21.6%, adjusted OR1.14; 95% CI 0.81–1.62, p = .451). Conclusions Successful ECV was associated with lower rate of one‐year recurrence in patients with early recurrent AF after catheter ablation.
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Affiliation(s)
- Zheng Dong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China.,Cardiovascular Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xin Du
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Xiao-Xia Hou
- Cardiovascular Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Liu He
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Jian-Zeng Dong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China.,Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chang-Sheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
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9
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Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, Boriani G, Castella M, Dan GA, Dilaveris PE, Fauchier L, Filippatos G, Kalman JM, Meir ML, Lane DA, Lebeau JP, Lettino M, Lip GY, Pinto FJ, Neil Thomas G, Valgimigli M, Van Gelder IC, Van Putte BP, Watkins CL. Guía ESC 2020 sobre el diagnóstico y tratamiento de la fibrilación auricular, desarrollada en colaboración de la European Association of Cardio-Thoracic Surgery (EACTS). Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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10
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Ferre-Vallverdu M, Ligero C, Vidal-Perez R, Martinez-Rubio A, Vinolas X, Alegret JM. Improvement in Atrial Fibrillation-Related Symptoms After Cardioversion: Role of NYHA Functional Class and Maintenance of Sinus Rhythm. Clin Interv Aging 2021; 16:739-745. [PMID: 33953552 PMCID: PMC8092854 DOI: 10.2147/cia.s305619] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 03/18/2021] [Indexed: 11/23/2022] Open
Abstract
Background The European Heart Rhythm Association (EHRA) score is a proven and validated tool for assessing the symptoms of atrial fibrillation (AF). Little is known about the variables related to this score and how it changes after cardioversion. Methods We analyzed 744 patients undergoing elective cardioversion in whom AF-related symptoms were assessed at baseline and after 6 months of follow-up using the EHRA score. We assessed the association between the EHRA score and other clinical and echocardiographic variables at baseline and after 6 months of follow-up. Results At 6 months of follow-up, we observed a reduction in the EHRA score in 50% and worsening in 2.8% of patients who remained in sinus rhythm (SR) compared with 34.6% and 11.3%, respectively, of patients with AF episodes (p<0.0001). Patients who maintained SR at 6 months were less symptomatic than those with AF (EHRA score 1.13 ± 0.35 vs 1.42 ± 0.59; p<0.0001). The independent predictors for reduction in the EHRA score after cardioversion were NYHA ≥II at baseline and maintenance of SR (p<0.0001). Conclusion The greatest improvement in AF-related symptoms was in patients who remained in SR at 6 months after cardioversion and in patients with worse NYHA functional class at baseline.
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Affiliation(s)
- Maria Ferre-Vallverdu
- Department of Cardiology, Hospital Universitari de Sant Joan.,Institut d'Investigació Sanitària Pere Virgili (IISPV).,Department of Medicine and Surgery of the University Rovira i Virgili; Reus, Spain
| | - Carmen Ligero
- Department of Cardiology, Hospital Universitari de Sant Joan.,Institut d'Investigació Sanitària Pere Virgili (IISPV).,Department of Medicine and Surgery of the University Rovira i Virgili; Reus, Spain
| | - Rafael Vidal-Perez
- Department of Cardiology, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | | | - Xavier Vinolas
- Department of Cardiology, Hospital de la Sta, Creu i St Pau, Barcelona, Spain
| | - Josep M Alegret
- Department of Cardiology, Hospital Universitari de Sant Joan.,Institut d'Investigació Sanitària Pere Virgili (IISPV).,Department of Medicine and Surgery of the University Rovira i Virgili; Reus, Spain
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11
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Lundqvist CB, Pürerfellner H, White A, Schilling R. Redefining the Standard for Atrial Fibrillation: A Patient-centric Report. Eur Cardiol 2021; 16. [PMID: 33859732 PMCID: PMC8034477 DOI: 10.15420/ecr.2021.16.s1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A roundtable discussion with three European clinical experts in AF and one expert patient diagnosed and treated for AF was conducted in London in October 2019. The panel discussed the implications of AF for patients, current patient pathways, what treatment outcomes were relevant for patients and how the recommendations for the management of AF may change in the future, based on the outcomes of recently published and on-going clinical trials. This article summarises the discussion, and draws upon wider sources to detail best practice and optimal patient treatment pathways.
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12
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Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, Boriani G, Castella M, Dan GA, Dilaveris PE, Fauchier L, Filippatos G, Kalman JM, La Meir M, Lane DA, Lebeau JP, Lettino M, Lip GYH, Pinto FJ, Thomas GN, Valgimigli M, Van Gelder IC, Van Putte BP, Watkins CL. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J 2021; 42:373-498. [PMID: 32860505 DOI: 10.1093/eurheartj/ehaa612] [Citation(s) in RCA: 5324] [Impact Index Per Article: 1774.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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13
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Ha AC, Stewart J, Klein G, Roy D, Connolly S, Koren A, Dorian P. Impact of electrical cardioversion on quality of life for patients with symptomatic persistent atrial fibrillation: Is there a treatment expectation effect? Am Heart J 2020; 226:152-160. [PMID: 32580074 DOI: 10.1016/j.ahj.2020.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 05/01/2020] [Indexed: 02/03/2023]
Abstract
It is assumed that electrical cardioversion (ECV) improves the quality of life (QoL) of patients with atrial fibrillation (AF) by restoring sinus rhythm (SR). OBJECTIVE We examined the effect of ECV and rhythm status on QoL of patients with symptomatic persistent AF in a randomized controlled trial. METHOD The elective cardioversion for prevention of symptomatic atrial fibrillation trial examined the efficacy of dronedarone around the time of ECV in maintaining SR. Quality of life was measured with the University of Toronto Atrial Fibrillation Severity Scale. The primary outcome was the change in AF symptom severity (∆AFSS) score over 6 months (0-35 points, with higher scores reflecting worse QoL and a minimal clinically important difference defined as ∆AFSS ≥3 points). Multivariable linear regression was performed to identify factors associated with changes in QoL. RESULTS We included 148 patients with complete AFSS scores at baseline and 6 months. Over 6 months, QoL improved irrespective of rhythm status (ΔAFSS scores for patients who (i) maintained SR; (ii) had AF relapse after successful ECV; and (iii) had unsuccessful ECV were -6.8 ± 6.4 points, -4.1 ± 6.2 points, and -4.0 ± 5.8 points respectively, P < .01 for all subgroups). After adjustment of baseline covariates, maintenance of SR was associated with QoL improvement (ΔAFSS: -3.8 points, 95% CI: -6.0 to -1.6 points, P < .01). CONCLUSIONS Maintenance of SR was associated with clinically relevant improvement in patients' QoL at 6 months. Patients with AF recurrence had a small but still relevant improvement in their QoL, potentially due to factors other than sinus rhythm.
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14
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Geurink K, Holmes D, Ezekowitz MD, Pieper K, Fonarow G, Kowey PR, Reiffel JA, Singer DE, Freeman J, Gersh BJ, Mahaffey KW, Hylek EM, Naccarelli G, Piccini JP, Peterson ED, Pokorney SD. Patterns of oral anticoagulation use with cardioversion in clinical practice. Heart 2020; 107:642-649. [PMID: 32591363 DOI: 10.1136/heartjnl-2019-316315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 05/05/2020] [Accepted: 05/07/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Cardioversion is common among patients with atrial fibrillation (AF). We hypothesised that novel oral anticoagulants (NOAC) used in clinical practice resulted in similar rates of stroke compared with vitamin K antagonists (VKA) for cardioversion. METHODS Using the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation II, patients with AF who had a cardioversion, follow-up data and an AF diagnosis within 6 months of enrolment were identified retrospectively. Clinical outcomes were compared for patients receiving a NOAC or VKA for 1 year following cardioversion. RESULTS Among 13 004 patients with AF, 2260 (17%) underwent cardioversion. 1613 met the inclusion criteria for this analysis. At the time of cardioversion, 283 (17.5%) were receiving a VKA and 1330 (82.5%) a NOAC. A transoesophageal echocardiogram (TOE) was performed in 403 (25%) cardioversions. The incidence of stroke/transient ischaemic attack (TIA) at 30 days was the same for patients having (3.04 per 100 patient-years) or not having (3.04 per 100 patient-years) a TOE (p=0.99). There were no differences in the incidence of death (HR 1.19, 95% CI 0.62 to 2.28, p=0.61), cardiovascular hospitalisation (HR 1.02, 95% CI 0.76 to 1.35, p=0.91), stroke/TIA (HR 1.18, 95% CI 0.30 to 4.74, p=0.81) or bleeding-related hospitalisation (HR 1.29, 95% CI 0.66 to 2.52, p=0.45) at 1 year for patients treated with either a NOAC or VKA. CONCLUSIONS Cardioversion was a low-risk procedure for patients treated with NOAC, and there were statistically similar rates of stroke/TIA 30 days after cardioversion as for patients treated with VKA. There were no statically significant differences in death, stroke/TIA or major bleeding at 1 year among patients treated with NOAC compared with VKA after cardioversion.
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Affiliation(s)
- Kyle Geurink
- Duke University Health System, Durham, North Carolina, USA
| | | | | | - Karen Pieper
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | | | - Peter R Kowey
- Cardiovascular Medicine, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA
| | - James A Reiffel
- Cardiovascular Medicine, College of Physicians and Surgeons-Columbia University, New York, New York, USA
| | | | - James Freeman
- Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | | | - Kenneth W Mahaffey
- Department of Medicine, Stanford Hospital and Clinics, Stanford, California, USA
| | - Elaine M Hylek
- Cardiovascular Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Gerald Naccarelli
- Penn State Hershey Heart and Vascular Institute, Hershey, Pennsylvania, USA
| | - Jonathan P Piccini
- Duke Clinical Research Institute, Durham, North Carolina, USA.,Duke University School of Medicine, Durham, North Carolina, USA
| | - Eric D Peterson
- Duke Clinical Research Institute, Durham, North Carolina, USA.,Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Sean D Pokorney
- Duke Clinical Research Institute, Durham, North Carolina, USA.,Duke University School of Medicine, Durham, North Carolina, USA
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Evans JM, Withers KL, Lencioni M, Carolan-Rees G, Wood KA, Patrick H, Griffith M. Quality of life benefits from arrhythmia ablation: A longitudinal study using the C-CAP questionnaire and EQ5D. Pacing Clin Electrophysiol 2019; 42:705-711. [PMID: 30933375 PMCID: PMC6850751 DOI: 10.1111/pace.13675] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 02/28/2019] [Accepted: 03/25/2019] [Indexed: 11/30/2022]
Abstract
AIMS To investigate long-term efficacy of cardiac ablation for symptomatic arrhythmia by gathering generic and arrhythmia-related quality of life data using patient-reported outcome measures before and after ablation. METHODS Consecutive patients undergoing cardiac ablation procedures at three sites in the United Kingdom were enrolled (n = 561). Data were collected at baseline, at 8-16 weeks, and 12 months after the ablation with responses from 390 patients received at all three time points. Nonparametric tests were used to identify any changes in patient outcomes due to nonnormal data. RESULTS There were significant improvements in symptom severity, impact on life scores, EQ-5D-5L indices, and visual analogue score (VAS) scores at pre- versus 3 months and at preablation versus 1 year. Impact on life score showed additional improvement at 1 year versus 3 months, while improvements in symptom severity, EQ-5D-5L indices, and VAS scores continued to be maintained between 3 months and 1 year. CONCLUSION Cardiac ablation provides patients with arrhythmias relief from symptoms, and results in an improvement in quality of life. Improvements observed at 3 months are maintained at 1 year follow-up.
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Affiliation(s)
- James M Evans
- Cedar, Cardiff & Vale University Health Board, Cardiff Medicentre, Heath Park, Cardiff, UK
| | - Kathleen L Withers
- Cedar, Cardiff & Vale University Health Board, Cardiff Medicentre, Heath Park, Cardiff, UK
| | - Mauro Lencioni
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Grace Carolan-Rees
- Cedar, Cardiff & Vale University Health Board, Cardiff Medicentre, Heath Park, Cardiff, UK
| | | | - Hannah Patrick
- National Institute for Health and Care Excellence, London, UK
| | - Michael Griffith
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, UK
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Chen LY, Chung MK, Allen LA, Ezekowitz M, Furie KL, McCabe P, Noseworthy PA, Perez MV, Turakhia MP. Atrial Fibrillation Burden: Moving Beyond Atrial Fibrillation as a Binary Entity: A Scientific Statement From the American Heart Association. Circulation 2018; 137:e623-e644. [DOI: 10.1161/cir.0000000000000568] [Citation(s) in RCA: 197] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Our understanding of the risk factors and complications of atrial fibrillation (AF) is based mostly on studies that have evaluated AF in a binary fashion (present or absent) and have not investigated AF burden. This scientific statement discusses the published literature and knowledge gaps related to methods of defining and measuring AF burden, the relationship of AF burden to cardiovascular and neurological outcomes, and the effect of lifestyle and risk factor modification on AF burden. Many studies examine outcomes by AF burden classified by AF type (paroxysmal versus nonparoxysmal); however, quantitatively, AF burden can be defined by longest duration, number of AF episodes during a monitoring period, and the proportion of time an individual is in AF during a monitoring period (expressed as a percentage). Current guidelines make identical recommendations for anticoagulation regardless of AF pattern or burden; however, a review of recent evidence suggests that higher AF burden is associated with higher risk of stroke. It is unclear whether the risk increases continuously or whether a threshold exists; if a threshold exists, it has not been defined. Higher burden of AF is also associated with higher prevalence and incidence of heart failure and higher risk of mortality, but not necessarily lower quality of life. A structured and comprehensive risk factor management program targeting risk factors, weight loss, and maintenance of a healthy weight appears to be effective in reducing AF burden. Despite this growing understanding of AF burden, research is needed into validation of definitions and measures of AF burden, determination of the threshold of AF burden that results in an increased risk of stroke that warrants anticoagulation, and discovery of the mechanisms underlying the weak temporal correlations of AF and stroke. Moreover, developments in monitoring technologies will likely change the landscape of long-term AF monitoring and could allow better definition of the significance of changes in AF burden over time.
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Dorian P, Ha AC. Cardioversion for Atrial Fibrillation Improves Quality of Life: It's Obvious (or Isn't It?). Can J Cardiol 2017; 33:425-427. [DOI: 10.1016/j.cjca.2017.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 01/19/2017] [Indexed: 10/20/2022] Open
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