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Quality of Life in Patients with Atrial Fibrillation: A Systematic Review

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Abstract

The impact of atrial fibrillation (AF) on patients’ quality of life (QoL) has yet to be fully elucidated in a systematic manner. This article examines QoL in “general” patients with AF as well as the effects that rate and/or rhythm-control interventions have on QoL. Patients with AF have significantly poorer QoL compared with healthy controls, the general population, and other patients with coronary heart disease. Studies examining rate or rhythm-control strategies alone demonstrate improved QoL after intervention. Three of the four large randomized control trials (STAF, PIAF, RACE) comparing rate versus rhythm control demonstrated a greater improvement in QoL in patients receiving rate control. However, the AFFIRM trial revealed a similar improvement in QoL for both rate and rhythm-control groups. The data, although frequently compromised by various methodologic weaknesses, suggest that patients with AF have impaired QoL, and that QoL can be significantly improved through rate or rhythm-control strategies.

Section snippets

Search Strategy

The electronic databases MEDLINE (1966 to January 31, 2005), EMBASE (1980 to January 31, 2005), PSYCHINFO (1887 to January 31, 2005), and CINAHL (1980 to January 31, 2005) were searched to identify potential articles. The following search terms were entered as Medical Subject Heading (MeSH) terms and textwords, or their equivalent, in the various databases: “Atrial Fibrillation,” “Atrial Flutter,” “Arrhythmia,” “Paroxysmal Atrial Fibrillation,” “Persistent Atrial Fibrillation,” “Permanent

Results

The searches resulted in 593 citations, of which 49 studies11, 12, 13, 14, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60 published between 1988 and 2005 met the inclusion criteria (Figure 1). All included studies were written in English with the exception of one, which was translated from German. The majority (89.8%) of studies assessed QoL in patients with AF

Discussion

Patients with AF have significantly poorer QoL compared with healthy controls,11, 12, 13, 16, 18, 19, 51 the general population,20, 38, 47 and other patients with coronary heart disease.16 The majority of studies examining QoL in patients with AF focused on highly selected and symptomatic patients undergoing interventions such as ablate and pace procedures,21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34 the Maze operation,46, 47, 48 PV isolation,40, 41, 43, 44 internal or external

References (64)

  • H.F. Tse et al.

    Effects of ventricular rate regularization pacing on quality of life and symptoms in patients with atrial fibrillation (Atrial fibrillation symptoms mediated by pacing to mean rates [AF SYMPTOMS study])

    Am J Cardiol.

    (2004)
  • M.S. Chen et al.

    Pulmonary vein ablation for the treatment of atrial fibrillation in patients with impaired systolic function

    J Am Coll Cardiol.

    (2004)
  • H. Purerfellner et al.

    Quality of life restored to normal in patients with atrial fibrillation after pulmonary vein ostial isolation

    Am Heart J

    (2004)
  • C. Berry et al.

    Electrical cardioversion for atrial fibrillationoutcomes in “real-life” clinical practice

    Int J Cardiol.

    (2001)
  • M. Kale et al.

    Atrial septal pacing in the prevention of paroxysmal atrial fibrillation refractory to antiarrhythmic drugs

    Int J Cardiol

    (2002)
  • D.M. Newman et al.

    Effect of an implantable cardioverter defibrillator with atrial detection and shock therapy on patient-perceived, health-related quality of life

    Am Heart J.

    (2003)
  • P. Dorian et al.

    Quality of life improves with treatment in the Canadian trial of atrial fibrillation

    Am Heart J.

    (2002)
  • C. Pappone et al.

    Mortality, morbidity, and quality of life after pulmonary vein ablation

    J Am Coll Cardiol.

    (2003)
  • H.A. Cooper et al.

    Relationship between achieved heart rate and outcomes in patients with atrial fibrillation (AFFIRM Study)

    Am J Cardiol.

    (2004)
  • B. Freestone et al.

    Epidemiology and costs of cardiac arrhythmias

  • S. Stewart et al.

    Cost of an emerging epidemican economic analysis of atrial fibrillation in the UK

    Heart

    (2004)
  • J.S. Steinberg

    Atrial fibrillationan emerging epidemic?

    Heart

    (2004)
  • P.A. Wolf et al.

    Impact of atrial fibrillation on mortality, stroke, and medical costs

    Arch Intern Med

    (1998)
  • H.S. Lim et al.

    Clinical reviewclinical management of atrial fibrillation—rate control versus rhythm control

    Crit Care

    (2004)
  • The constitution of the World Health Organisation

    WHO Chronicle.

    (1947)
  • C. Sanders et al.

    Reporting on quality of life in randomised controlled trialsbibliographic study

    BMJ

    (1998)
  • N. Houston-Miller

    Compliance with treatment regimes in chronic asymptomatic diseases

    Am J Med.

    (1997)
  • R. Fitzpatrick et al.

    Quality of life measures in health careapplications and issues in assessment

    BMJ

    (1992)
  • B. Lüderitz et al.

    Quality of life in patients with atrial fibrillation

    Arch Intern Med.

    (2000)
  • G.C. Gronefeld et al.

    Impact of rate versus rhythm control on quality of life in patients with persistent atrial fibrillation

    Eur Heart J.

    (2003)
  • L.S. Jenkins et al.

    Quality of life in atrial fibrillationthe Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study

    Am Heart J

    (2005)
  • D.F. Stroup et al.

    Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group

    JAMA

    (2000)
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