Clinically Meaningful Change in Quality of Life and Associated Factors Among Older Patients With Atrial Fibrillation.
Clinically Meaningful Change in Quality of Life and Associated Factors Among Older Patients With Atrial Fibrillation.
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DOI：
10.1161/jaha.120.016651
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发表时间：
2020-09-15
影响因子：
5.4
通讯作者：
McManus DD
中科院分区：
文献类型：
--
作者：
Abu HO;Saczynski JS;Mehawej J;Tisminetzky M;Kiefe CI;Goldberg RJ;McManus DD
在老年房颤患者中，检查生活质量（QoL）有临床意义变化的数据有限。我们研究了老年房颤患者1年内生活质量有临床意义变化的程度和相关因素。来自马萨诸塞州和格鲁吉亚心脏病学、电生理学和初级保健诊所的患者入组了一项队列研究（2015-2018）。房颤对生活质量的影响问卷用于评估总体QoL和3个分量表：症状、日常活动和治疗问题。QoL中有临床意义的变化（即1年和基线QoL评分之间的差异）被分类为下降（≤-5.0分）、无临床意义的变化（-5.0至+5.0分）或增加（≥+5.0分）。有序逻辑模型用于检查与生活质量变化相关的因素。参与者（n=1097）平均年龄为75岁，48%为女性，87%为白色。大约40%的患者出现了具有临床意义的QoL增加，每5例患者中有1例出现了QoL下降。多变量校正后，女性、非白人、报告抑郁和焦虑症状、自我健康评定一般/较差、社会支持低、心力衰竭或糖尿病的患者的QoL出现具有临床意义的下降。这些发现提供了对老年房颤患者生活质量有临床意义的变化幅度和相关因素的见解。评估合并症和心理社会因素可能有助于识别QoL下降的高风险患者以及需要额外监测的患者，以最大限度地提高重要的临床和以患者为中心的结局。
Among older patients with atrial fibrillation, there are limited data examining clinically meaningful changes in quality of life (QoL). We examined the extent of, and factors associated with, clinically meaningful change in QoL over 1‐year among older adults with atrial fibrillation. Patients from cardiology, electrophysiology, and primary care clinics in Massachusetts and Georgia were enrolled in a cohort study (2015–2018). The Atrial Fibrillation Effect on Quality‐of‐Life questionnaire was used to assess overall QoL and across 3 subscales: symptoms, daily activities, and treatment concern. Clinically meaningful change in QoL (ie, difference between 1‐year and baseline QoL score) was categorized as either a decline (≤−5.0 points), no clinically meaningful change (−5.0 to +5.0 points), or an increase (≥+5.0 points). Ordinal logistic models were used to examine factors associated with QoL changes. Participants (n=1097) were on average 75 years old, 48% were women, and 87% White. Approximately 40% experienced a clinically meaningful increase in QoL and 1 in every 5 patients experienced a decline in QoL. After multivariable adjustment, women, non‐Whites, those who reported depressive and anxiety symptoms, fair/poor self‐rated health, low social support, heart failure, or diabetes mellitus experienced clinically meaningful declines in QoL. These findings provide insights to the magnitude of, and factors associated with, clinically meaningful change in QoL among older patients with atrial fibrillation. Assessment of comorbidities and psychosocial factors may help identify patients at high risk for declining QoL and those who require additional surveillance to maximize important clinical and patient‐centered outcomes.