Association of sex and atrial fibrillation therapies with patient-reported outcomes

Kelly Therese Gleason, Cheryl Renee Dennison Himmelfarb, Daniel Ernest Ford, Harold Lehmann, Laura Samuel, Sandeep Jain, Gerald Naccarelli, Vikas Aggarwal, Saman Nazarian, Kelly Therese Gleason, Cheryl Renee Dennison Himmelfarb, Daniel Ernest Ford, Harold Lehmann, Laura Samuel, Sandeep Jain, Gerald Naccarelli, Vikas Aggarwal, Saman Nazarian

Abstract

Objectives: Women report higher atrial fibrillation (AF) symptom severity and receive less AF therapies than their male counterparts. It is understudied if differences in AF therapies received explains sex differences in AF symptom severity. We investigate the impact of sex and AF therapies on patient-reported outcomes.

Methods: Participants were recruited (n=953) across four academic medical centres with an AF diagnosis and age ≥18 years. Patient-reported outcomes (AF symptom severity, AF-related quality of life, functional status and emotional status) were determined by biannual surveys. We performed multiple linear regressions on propensity-matched cohorts to determine the association of AF therapies and sex on patient-reported outcomes.

Results: Our study population (n=953) was 65% male (n=616), 93% white (n=890) and 72 (±10) years old. Individuals receiving rate control therapy reported comparatively lower AF-related quality of life (-7.22, 95% CI -11.51 to -2.92) and poorer functional status (-3.69, 95% CI -5.27 to -2.12). Individuals receiving rhythm control strategies did not report significantly different patient-reported outcomes. Women were more likely to report poorer functional status (-2.63, 95% CI -3.86 to -1.40) and poorer AF-related quality of life, higher anxiety (2.33, 95% CI 1.07 to 3.59), higher symptoms of depression (1.48, 95% CI 0.31 to 2.65) and AF symptom severity (0.29, 95% CI 0.07 to 0.52).

Conclusions: Female sex was associated with comparatively poorer AF symptom severity and quality of life, and this association remained after accounting for AF therapies received. Receiving rate control medication alone was associated with comparatively poorer AF-related quality of life and functional status.

Keywords: atrial fibrillation; electronic medical records; health care delivery; quality and outcomes of care.

Conflict of interest statement

Competing interests: SN is a scientific advisor to Biosense Webster, Siemens, Imricor and CardioSolv Inc and principal investigator for research funding to the University of Pennsylvania from Biosense Webster, Siemens and Imricor Inc. SJ receives research support from Medtronic and is a principal investigator for research funding to the University of Pittsburgh from Medtronic, Boston Scientific and St. Jude Medical. GN receives research support from Janssen and serves as a scientific advisor to Janssen, Milestone, Omeicos, Glaxo-Smith-Kline and Aceion.

© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
The association of therapies and key patient characteristics with atrial fibrillation-related quality of life in propensity score matched adjust models. Notes: results presented as β, 95% CI. The reference groups for sex, education level, comorbidity index and weight were male sex, greater than college, comorbidity index of 0 and normal weight. *Comorbidity index.

References

    1. January CT. AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: Executive Summary. Circulation 2014;2014.
    1. McCabe PJ, Schumacher K, Barnason SA. Living with atrial fibrillation: a qualitative study. J Cardiovasc Nurs 2011;26:336–44.
    1. Thompson TS, Barksdale DJ, Sears SF, et al. The effect of anxiety and depression on symptoms attributed to atrial fibrillation. Pacing Clin Electrophysiol 2014;37:439–46.
    1. Ha ACT. Health-related quality of life in patients with atrial fibrillation treated with rhythm control versus rate control: Insights from a prospective international registry (registry on cardiac rhythm disorders assessing the control of atrial fibrillation: REC. Circ. Cardiovasc. Qual. Outcomes 2014.
    1. C hung MK, Shemanski L, Sherman DG, et al. Functional status in rate-versus rhythmcontrol strategies for atrial fibrillation: results of the Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) functional status substudy. J Am Coll Cardiol 2005;46.
    1. Lane DA, Aguinaga L, Blomström-Lundqvist C, et al. Cardiac tachyarrhythmias and patient values and preferences for their management: the European Heart Rhythm Association (EHRA) consensus document endorsed by the Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLEACE). Europace 2015;17:1747–69.
    1. Schnabel RB, Pecen L, Ojeda FM, et al. Gender differences in clinical presentation and 1-year outcomes in atrial fibrillation. Heart 2017;103:1024–30.
    1. Dagres N, Nieuwlaat R, Vardas PE, et al. Gender-related differences in presentation, treatment, and outcome of patients with atrial fibrillation in Europe: a report from the Euro Heart Survey on Atrial Fibrillation. J Am Coll Cardiol 2007;49:572–7.
    1. Lip GY, Laroche C, Boriani G, et al. Sex-related differences in presentation, treatment, and outcome of patients with atrial fibrillation in Europe: a report from the Euro Observational Research Programme Pilot survey on Atrial Fibrillation. Europace 2015;17:24–31.
    1. Havranek EP, Mujahid MS, Barr DA, et al. Social Determinants of Risk and Outcomes for Cardiovascular Disease: A Scientific Statement From the American Heart Association. Circulation 2015;132:873–98.
    1. Reynolds MR, Lavelle T, Essebag V et al. Influence of age, sex, and atrial fibrillation recurrence on quality of life outcomes in a population of patients with new-onset atrial fibrillation: the Fibrillation Registry Assessing Costs, Therapies, Adverse events and Lifestyle (FRACTAL) study. Am Heart J 2006;152:1097–103.
    1. Goli NM, et al. Educational attainment is associated with atrial fibrillation symptom severity. PACE - Pacing Clin. Electrophysiol 2012.
    1. Bhave PD, Lu X, Girotra S, et al. Race- and sex-related differences in care for patients newly diagnosed with atrial fibrillation. Heart Rhythm 2015;12:1406–12.
    1. Amin W, Tsui FR, Borromeo C, et al. PaTH: towards a learning health system in the Mid-Atlantic region. J Am Med Inform Assoc 2014;21:633–6.
    1. Gleason KT, Ford DE, Gumas D, et al. Development and preliminary evaluation of a patient portal messaging for research recruitment service. J Clin Transl Sci 2018;2:53–6.
    1. Spertus J, Dorian P, Bubien R, et al. Development and validation of the Atrial Fibrillation Effect on QualiTy-of-Life (AFEQT) Questionnaire in patients with atrial fibrillation. Circ Arrhythm Electrophysiol 2011;4:15–25.
    1. Cella D, Riley W, Stone A, et al. The Patient-Reported Outcomes Measurement Information System (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005-2008. J Clin Epidemiol 2010;63:1179–94.
    1. Pilkonis PA, Choi SW, Reise SP, et al. Item banks for measuring emotional distress from the Patient-Reported Outcomes Measurement Information System (PROMIS®): depression, anxiety, and anger. Assessment 2011;18:263–83.
    1. Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 1992;45:613–9.
    1. Bounthavong M, Watanabe JH, Sullivan KM. Approach to addressing missing data for electronic medical records and pharmacy claims data research. Pharmacotherapy 2015;35:380–7.
    1. Rubin DB, Thomas N. Combining propensity score matching with additional adjustments for prognostic covariates. J Am Stat Assoc 2000;95:573–85.
    1. Ha AC, Breithardt G, Camm AJ, et al. Health-related quality of life in patients with atrial fibrillation treated with rhythm control versus rate control: insights from a prospective international registry (Registry on Cardiac Rhythm Disorders Assessing the Control of Atrial Fibrillation: RECORD-AF). Circ Cardiovasc Qual Outcomes 2014;7:896–904.
    1. Fichtner S, Deisenhofer I, Kindsmüller S, et al. Prospective assessment of short- and long-term quality of life after ablation for atrial fibrillation. J Cardiovasc Electrophysiol 2012;23:121–7.
    1. Ko DT, Hebert PR, Coffey CS, et al. Beta-blocker therapy and symptoms of depression, fatigue, and sexual dysfunction. JAMA 2002;288:351.
    1. Gleason KT, Dennison Himmelfarb CR, Ford DE, et al. Association of sex, age and education level with patient reported outcomes in atrial fibrillation. BMC Cardiovasc Disord 2019;19:85.
    1. Forleo GB, Tondo C, De Luca L, et al. Gender-related differences in catheter ablation of atrial fibrillation. Europace 2007;9:613–20.
    1. Winkle RA, Mead RH, Engel G, et al. Long-term results of atrial fibrillation ablation: the importance of all initial ablation failures undergoing a repeat ablation. Am Heart J 2011;162:193–200.
    1. Kurokawa J, Kodama M, Clancy CE, et al. Sex hormonal regulation of cardiac ion channels in drug-induced QT syndromes. Pharmacol Ther 2016;168:23–8.
    1. Schnabel RB, Michal M, Wilde S, et al. Depression in atrial fibrillation in the general population. PLoSOne 2013;8:e79109.
    1. Kirchhof P ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Russian Journal of Cardiology 2016.

Source: PubMed

赞助者和合作者

医疗条件

药物干预

3
订阅