Factors associated with low health-related quality of life among younger and older Thai patients with non-valvular atrial fibrillation

  • Varalak Srinonprasert
  • Kasem Ratanasumawong
  • Tomon Thongsri
  • Somchai Dutsadeevettakul
  • Pongpun Jittham
  • Weerapan Wiwatworapan
  • Rungroj KrittayaphongEmail author
  • COOL AF Investigators



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.


Atrial 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.

Ethical approval

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.

Informed consent

All patients provided written informed consent prior to participation.


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Varalak Srinonprasert
    • 1
  • Kasem Ratanasumawong
    • 2
  • Tomon Thongsri
    • 3
  • Somchai Dutsadeevettakul
    • 4
  • Pongpun Jittham
    • 5
  • Weerapan Wiwatworapan
    • 6
  • Rungroj Krittayaphong
    • 1
    • 7
    Email author
  • COOL AF Investigators
  1. 1.Faculty of Medicine Siriraj HospitalMahidol UniversityBangkokThailand
  2. 2.Police General HospitalBangkokThailand
  3. 3.Buddhachinaraj HospitalPhitsanulokThailand
  4. 4.Golden Jubilee Medical CenterNakhon PathomThailand
  5. 5.Naresuan UniversityPhitsanulokThailand
  6. 6.Maharat Nakorn Ratchasima HospitalNakorn RatchasimaThailand
  7. 7.Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj HospitalMahidol UniversityBangkokThailand

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