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Patient-reported outcomes and the identification of subgroups of atrial fibrillation patients: a retrospective cohort study of linked clinical registry and administrative data

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Abstract

Purpose

Previous research about the health and quality of life of people with atrial fibrillation has typically identified a single health trajectory. Our study aimed to examine variability in health trajectories and patient characteristics associated with such variability.

Methods

We conducted a retrospective analysis of data collected between 2008 and 2016 for a cardiac registry in British Columbia (Canada) linked with administrative health data. The Atrial Fibrillation Effect on Quality of Life Questionnaire was used to measure health status at up to 10 clinic visits. Growth mixture models were used and a three-step multinomial logistic regression was conducted to identify predictors of subgroups with different trajectories.

Results

The patients (N = 7439) were primarily men (61.1%) over 60 years of age (72.9%). Three subgroups of health status trajectories were identified: “poor but improving”, “good and stable”, and “excellent and stable” health. Compared with the other two groups, patients in the “poor but improving group” were more likely to (1) be less than 60 years of age; (2) be women; (3) have greater risk of stroke; (4) have had ablation therapy within 6 months to 1 year or more than 2 years after their initial consultation; and (5) have had anticoagulation therapy within 6 months.

Conclusion

Using growth mixture models, we found that not all health trajectories are the same. These models can help to understand variability in trajectories with different patient characteristics that could inform tailored interventions and patient education strategies.

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Data Availability

Data sharing agreements prohibit the dataset from being made publicly available. Access may be granted to those who meet pre-specified criteria for confidential access. The statistical analysis code is available from the corresponding author upon request.

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Acknowledgements

All inferences, opinions, and conclusions drawn from various data sources are those of the authors, and they do not reflect the opinions or policies of the data steward(s). We would like to thank Dr. Sandra Lauck for contributing her clinical expertise and informative discussion. The following work forms part of a thesis dissertation and the abstract was published as part of the ISOQOL conference proceedings.

Funding

The study was supported by the University of British Columbia Fellowship program, Canadian Nurses Foundation, and the Lyle Creelman Endowment Fund.

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Authors and Affiliations

  1. School of Nursing, University of British Columbia, Vancouver, Canada

    Jae-Yung Kwon & Jennifer Baumbusch

  2. School of Nursing, Trinity Western University, 22500 University Drive, Langley, BC, V2Y 1Y1, Canada

    Jae-Yung Kwon & Richard Sawatzky

  3. Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, Canada

    Richard Sawatzky

  4. Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

    Richard Sawatzky

  5. Department of Educational and Counselling Psychology, and Special Education, Faculty of Education, University of British Columbia, Vancouver, BC, Canada

    Pamela A. Ratner

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  1. Jae-Yung Kwon
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Correspondence to Jae-Yung Kwon.

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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. This study was approved by the institutional ethics review board (University of British Columbia Behavioural Research Ethics Board (H16-03439)).

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Kwon, JY., Sawatzky, R., Baumbusch, J. et al. Patient-reported outcomes and the identification of subgroups of atrial fibrillation patients: a retrospective cohort study of linked clinical registry and administrative data. Qual Life Res 30, 1547–1559 (2021). https://doi.org/10.1007/s11136-021-02777-6

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