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Publications

Journal Article Ahead of print

PubMed: 42683919 DOI: 10.1097/HPC.0000000000000439

Redefining atrial fibrillation treatment success: patient-defined goals for arrhythmia burden and health-related quality of life.

Crit Pathw Cardiol

Authors: Alexander E Kolomaya, Brian Zenger, Michael Torre, Andrew Redd, T Jared Bunch, Trudie Lobban, Morgan M Millar, Jonathan P Piccini, John A Spertus, Rachel Hess, Benjamin A Steinberg

Affiliations

  • University of Utah Health Sciences, Salt Lake City, UT.
  • Washington University in St Louis, Department of Medicine, St. Louis, MO.
  • Arrhythmia Alliance.
  • Duke University Medical Center and Duke Clinical Research Institute, Durham, NC.
  • University of Missouri - Kansas City's Healthcare Institute for Innovations in Quality and Saint Luke's Mid America Heart Institute, Kansas City, MO.
  • Denver Health Medical Center, Denver, CO.
  • University of Colorado Anschutz Medical Campus, Aurora, CO.
  • CPC Clinical Research, Aurora, CO.

Abstract

BACKGROUND

Despite the use of atrial fibrillation (AF) cutoff of 30s as the standard for success in most AF clinical trials, patients consider an AF Severity Scale (AFSS) of ≤ 5 or AF duration ≤ 1 hour as treatment success. Prevalence and factors associated with these patient-defined endpoints are unknown.

METHODS

We performed a cross-sectional analysis using a single-site cohort of AF patients. We report rates of patient-defined treatment success (AFSS ≤ 5 or AF burden ≤ 1 hour) and multivariable analyses to identify factors associated with either successful outcome.

RESULTS

From 2019 to 2023, 2087 patients had available AFSS symptom scores and 2305 had ambulatory ECG monitoring. Of these, 862 (41%) had AFSS scores ≤5 and 1130 (49%) had AF burden ≤1 hour. After adjusted analysis, older age (OR 1.03, 95% CI 1.02-1.04, p <0.001) was associated with AFSS ≤5. Whereas female sex (OR 0.43, 95% CI 0.35-0.52, p <0.001), CKD, COPD, depression, and CHF were less likely to meet AFSS threshold. Among the AF burden cohort, age (OR 0.98, 95% CI 0.97-0.99, p <0.001), and female sex (OR 1.24, 95% CI 1.03-1.50, p=0.025) were associated with AF burden ≤ 1 hour. Unlike the AFSS cohort, medical comorbidities such as COPD and CHF, were not significantly different for meeting AF burden goal.

CONCLUSION

Less than half of AF patients had AF-symptom scores or arrhythmia burdens reflecting patient-defined treatment success. Factors associated with reaching patient reported outcome goals were distinct from those associated with arrhythmia burden goals.

MeSH

Quality Of Life, Arrhythmias, Cardiac, Cardiovascular Diseases, Atrial Fibrillation, Sex, Therapeutics