Factors associated with low health-related quality of life among younger and older Thai patients with non-valvular atrial fibrillation
The aim of this study was to investigate the factors associated with low health-related quality of life (HRQoL) compared between younger and older Thai patients with non-valvular atrial fibrillation (NVAF).
This is a cross-sectional analysis of baseline data from a prospective NVAF registry from 24 hospitals located across Thailand. Patient demographic, clinical, lifestyle, and medication data were collected at baseline. EuroQOL/EQ-5D-3L was used to assess HRQoL. Health utility was calculated for the entire study population, and low HRQoL was defined as the lowest quartile. Multivariate logistic regression was used to identify factors that significantly predict low HRQoL among younger and older (≥ 65 years) patients with NVAF.
Among the 3218 participants that were enrolled, 61.0% were aged older than 65 years. Mean HRQoL was lower in older than in younger patients (0.72 ± 0.26 vs. 0.84 ± 0.20; p < 0.001). Factors associated with low HRQoL among younger NVAF patients were the treatment-related factors bleeding history (p = 0.006) and taking warfarin (p = 0.001). Among older patients, the NVAF-related complications ischemic stroke or TIA, heart failure (HF), and dementia (all p < 0.001) were all significantly associated with low HRQoL. Dementia is the factor that most adversely influences low HRQoL among older NVAF. Interestingly, symptomatic NVAF was found to be a protective factor for low HRQoL (p < 0.001).
Bleeding history and taking warfarin among younger patients, and ischemic stroke/TIA, HF, and dementia among older patients are significant predictors of low HRQoL. These factors should be taken into consideration when selecting treatment options for patients with NVAF.
KeywordsAtrial fibrillation Health-related quality of life Thai patients
The authors gratefully acknowledge the patients that generously agreed to participate in this study, and Dr. Suthipol Udompanturak of the Division of Clinical Epidemiology, Department of Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University for assistance with statistical analysis. Buddhachinaraj Hospital: Tomorn Thongsri, MD; Central Chest Institute of Thailand: Kriengkrai Hengrussamee, MD; Charoen Krung Pracha Rak Hospital: Pattraporn Srirattana, MD; Chiangrai Prachanukroh Hospital: Wattana Wongtheptien, MD; Chonburi Hospital: Pornchai Ngamjanyaporn, MD; Faculty of Medicine, Chiang Mai University: Arintaya Phrommintikul, MD; Faculty of Medicine, Chulalongkorn University: Smonporn Boonyaratavej, MD; Faculty of Medicine, Naresuan University: Pongpun Jittham, MD; Faculty of Medicine, Prince of Songkla University: Treechada Wisaratapong, MD; Faculty of Medicine Ramathibodi Hospital, Mahidol University: Sirin Apiyasawat, MD; Faculty of Medicine Siriraj Hospital, Mahidol University: Arjbordin Winijkul, MD, Rungroj Krittayaphong, MD; Faculty of Medicine, Thammasat University (Rangsit Campus): Roj Rojjarekampai, MD; Faculty of Medicine Vajira Hospital, Navamindradhiraj University: Kulyot Jongpiputvanich, MD; Golden Jubilee Medical Center: Somchai Dutsadeevettakul, MD; Srinakarind Hospital, Faculty of Medicine, Khon Kaen University: Chaiyasith Wongvipaporn, MD; Lampang Hospital: Thanita Boonyapiphat, MD; Maharat Nakorn Ratchasima Hospital: Weerapan Wiwatworapan, MD; Nakornping Hospital: Khanchai Siriwattana, MD; Pattani Hospital: Eakarnantha Arnanththanitha, MD; Photharam Hospital: Watchara Konkaew, MD; Phramongkutklao College of Medicine: Thoranis Chantrarat, MD; Police General Hospital: Kasem Ratanasumawong, MD; Prapokklao Hospital (Chanthaburi): Wiwat Kanjanarutjawiwat, MD; Queen Savang Vadhana Memorial Hospital: Sakaorat Kornbongkotmas; MD; Ratchaburi Hospital: Thanasak Patmuk, MD; Sapphasitthiprasong Hospital: Praprut Thanakitcharu, MD; Surat Thani Hospital: Suchart Arunsiriwattana, MD; Surin Hospital: Thaworn Choochunklin; MD; Udon Thani Hospital: Sumon Tangsuntornwiwat, MD.
This study was funded by the Health Systems Research Institute (HSRI), Nonthaburi, Thailand (Grant No. 59-053), The Heart Association of Thailand under the Royal Patronage of H.M. the King, Bangkok, Thailand, and The Royal College of Physicians of Thailand, Bangkok, Thailand.
Compliance with ethical standards
Conflict of interest
All authors declare no personal or professional conflicts of interest.
The protocol for this study was approved by the institutional review boards of the Thailand Ministry of Public Health and all participating hospitals. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
All patients provided written informed consent prior to participation.
- 3.Calkins, H., Kuck, K. H., Cappato, R., Brugada, J., Camm, A. J., Chen, S. A., et al. (2012). 2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: Recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design. Journal of Interventional Cardiac Electrophysiology, 33(2), 171–257.CrossRefGoogle Scholar
- 10.Hsu, N. W., Tsao, H. M., Chen, H. C., Lo, S. S., Chen, S. A., & Chou, P. (2016). Different impacts of atrial fibrillation and cardiac premature contractions on the health-related quality of life in elderly people: The Yilan Study. The Tohoku Journal of Experimental Medicine, 238(1), 75–83.CrossRefGoogle Scholar
- 11.Wang, K. L., Wu, C. H., Huang, C. C., Wu, T. C., Naditch-Brule, L., Steg, P. G., et al. (2014). Complexity of atrial fibrillation patients and management in Chinese ethnicity in routine daily practice: Insights from the RealiseAF Taiwanese cohort. Journal of Cardiology, 64(3), 211–217.CrossRefGoogle Scholar
- 12.Inohara, T., Kimura, T., Ueda, I., Ikemura, N., Tanimoto, K., Nishiyama, N., et al. (2017). Effect of compliance to updated AHA/acc performance and quality measures among patients with atrial fibrillation on outcome (from Japanese Multicenter Registry). The American Journal of Cardiology, 120(4), 595–600.CrossRefGoogle Scholar
- 13.Krittayaphong, R., Winijkul, A., Methavigul, K., Wongtheptien, W., Wongvipaporn, C., Wisaratapong, T., et al. (2018). Risk profiles and pattern of antithrombotic use in patients with non-valvular atrial fibrillation in Thailand: A multicenter study. BMC Cardiovascular Disorders, 18(1), 174.CrossRefGoogle Scholar
- 18.Ha, A. C., Breithardt, G., Camm, A. J., Crijns, H. J., Fitzmaurice, G. M., Kowey, P. R., et al. (2014). 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). Circulation: Cardiovascular Quality and Outcomes, 7(6), 896–904.Google Scholar
- 19.Freeman, J. V., Simon, D. N., Go, A. S., Spertus, J., Fonarow, G. C., Gersh, B. J., et al. (2015). Association between atrial fibrillation symptoms, quality of life, and patient outcomes: Results from the outcomes registry for better informed treatment of atrial fibrillation (ORBIT-AF). Circulation: Cardiovascular Quality and Outcomes, 8(4), 393–402.Google Scholar
- 20.Biteker, M., Basaran, O., Dogan, V., Altun, I., Ozpamuk Karadeniz, F., Tekkesin, A. I., et al. (2017). Real-world clinical characteristics and treatment patterns of individuals aged 80 and older with nonvalvular atrial fibrillation: Results from the ReAl-life Multicenter Survey Evaluating Stroke Study. Journal of the American Geriatrics Society, 65(8), 1684–1690.CrossRefGoogle Scholar
- 22.Steg, P. G., Alam, S., Chiang, C.-E., Gamra, H., Goethals, M., Inoue, H., et al. (2012). Symptoms, functional status and quality of life in patients with controlled and uncontrolled atrial fibrillation: Data from the RealiseAF cross-sectional international registry. Heart, 98(3), 195–201.CrossRefGoogle Scholar