Treatment strategies and subsequent changes in the patient-reported quality-of-life among elderly patients with atrial fibrillation
Treatment strategies and subsequent changes in the patient-reported quality-of-life among elderly patients with atrial fibrillation
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DOI：
10.1016/j.ahj.2020.01.011
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发表时间：
2020-04-01
影响因子：
4.8
通讯作者：
Kohsaka, Shun
中科院分区：
文献类型：
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作者：
Miura, Kotaro;Ikemura, Nobuhiro;Kohsaka, Shun
心律控制策略，包括导管消融（CA）的应用，构成了房颤（AF）治疗的一个组成部分。然而，老年患者在临床试验中的代表性不足，各种节律控制治疗的患者报告结果的报告仍然有限。因此，我们的目的是调查的应用程序的节律控制策略，老年患者AF。方法使用前瞻性，多中心日本注册，我们分析了733例房颤患者年龄≥ 70岁，完成了房颤对生活质量的影响（AFEQT）的问卷调查，在基线和1年的访问。结果321例（43.8%）患者接受了心律控制策略治疗，其中125例（17.1%）患者接受了抗心律失常药物（AAD）治疗，196例（26.7%）患者接受了CA治疗。与心率控制组相比，节律控制组更年轻，合并症的可能性更小，但基线AFEQT总体汇总（OS）评分较低（71.8 [标准差20.3] vs. 80.0 [标准差16.1]; P <0.001）。第一年后，无论治疗策略如何（即心率或节律控制），AFEQT-OS评分均有所改善。校正混杂因素后，CA实施和基线AFEQT评分较低与QOL有意义的改善相关（AFEQT-OS评分变化>= 5）。生活质量改善与抗心律失常药物单独的节律控制患者的亚组之间是没有临床意义的。结论在当代日本的临床实践中，节律控制策略被广泛实施的老年患者AF，CA的使用与生活质量改善精心挑选的患者。
Background Rhythm-control strategy, including catheter ablation (CA) application, constitutes an integral part of atrial fibrillation (AF) management. However, elderly patients are underrepresented in clinical trials, and reports on patient-reported outcome of various rhythm-control treatments remain limited. Therefore, we aimed to investigate the application of a rhythm-control strategy for elderly patients with AF.Methods Using a prospective, multicenter Japanese registry, we analyzed 733 patients with AF aged >= 70 years who completed the Atrial Fibrillation Effect on Quality-of-Life (AFEQT) questionnaire at baseline and 1-year visit. Improvement in patient-reported quality-of-life (QOL) was assessed according to their initial treatment strategy.Results A total of 321 patients (43.8%) were managed with rhythm-control strategy, of which 125 (17.1%) received treatment with antiarrhythmic drugs (AADs) alone and 196 (26.7%) underwent CA. Compared with the rate-control group, the rhythm-control group was younger and less likely to have comorbid conditions but had lower baseline AFEQT-overall summary (OS) scores (71.8 [standard deviation 20.3] vs. 80.0 [standard deviation 16.1]; P < .001). After the first year, AFEQT-OS scores improved regardless of treatment strategies (ie, rate- or rhythm-control). After adjusting for confounders, CA implementation and a lower baseline AFEQT score were associated with meaningful improvement in QOL (changes in AFEQT-OS score >= 5). QOL improvement among subgroups of rhythm-control patients with AADs alone was not clinically meaningful.Conclusions In contemporary Japanese clinical practice, rhythm-control strategy is widely implemented in elderly patients with AF, and CA use is associated with improvement in QOL in carefully selected patients.