Treatment strategies and subsequent changes in the patient-reported quality-of-life among elderly patients with atrial fibrillation

2020 ◽  
Vol 222 ◽  
pp. 83-92 ◽  
Author(s):  
Kotaro Miura ◽  
Nobuhiro Ikemura ◽  
Takehiro Kimura ◽  
Yoshinori Katsumata ◽  
Ikuko Ueda ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Atrial Fibrillation ◽  
Elderly Patients ◽  
Treatment Strategies ◽  
Patient Reported

scholarly journals Cohort profile: patient characteristics and quality-of-life measurements for newly-referred patients with atrial fibrillation—Keio interhospital Cardiovascular Studies-atrial fibrillation (KiCS-AF)

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e032746 ◽  
Author(s):  
Nobuhiro Ikemura ◽  
John A Spertus ◽  
Takehiro Kimura ◽  
Kenneth Mahaffey ◽  
Jonathan P Piccini ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Atrial Fibrillation ◽  
Assessment Tool ◽  
Oral Anticoagulant Therapy ◽  
Treatment Strategies ◽  
Summary Score ◽  
Individual Treatment ◽  
Patient Reported

PurposeBesides the high rates of morbidity and mortality, atrial fibrillation (AF) is also associated with impairment of quality-of-life (QOL). However, reports covering non-selected AF population within Asian countries remain scarce. The objective of the Keio interhospital Cardiovascular Studies-atrial fibrillation (KiCS-AF) registry is to clarify the baseline and QOL profiles of the AF patients at the time of initial referral to identify areas for improvement and country-specific gaps.ParticipantsThe KiCS-AF registry is a multicentre, prospective cohort study designed to specifically recruit AF patients newly referred to the 11 network hospitals within the Kanto area of Japan. The registry completed its enrolment in June 2018. All patients were requested to answer the Atrial Fibrillation Effect on Quality-of-Life (AFEQT) questionnaire both at baseline and 1 year, with planned clinical follow-up for 5 years. The registry also assessed individual treatment strategies including rate and rhythm control, stroke prophylaxis, and their impacts on patient-reported QOL.Findings to dateAs of December 2016, 2464 AF patients were registered; their mean age was 67.1 years (SD, 11.7), majority (69.7%; n=1717) were men and 49.2% presented with paroxysmal AF. The mean CHA2DS2-VASc (cardiac failure or dysfunction, hypertension, age ≥75 years, diabetes, stroke including vascular disease, age 65-74 years, and sex category [female]) score was 2.3 (SD, 1.6) and oral anticoagulant therapy was used for 88.6% of patients with CHA2DS2-VASc scores ≥2. The median AFEQT-overall summary score was 79.1 (IQR, 66.6–89.1). Roughly 50% had significantly impaired QOL (ie, AFEQT <80) at baseline. Currently, 2307 eligible patients (93.6%) have completed the 1-year follow-up, of which 2072 patients (89.8%) answered the second AFEQT questionnaire.Future plansThe KiCS-AF allowed for extensive investigation of AF-related QOL in a non-selected population with long-term follow-up using a rigorously validated QOL assessment tool. Almost half of patients had impaired QOL at baseline. Further investigations aimed at providing care and improving patient-reported QOL are required.

scholarly journals Effects of Pharmacologic Therapy on Health-Related Quality of Life in Elderly patients with Atrial Fibrillation: A systematic Review of Randomized and Nonrandomized Trials

2013 ◽  
Vol 7 ◽  
pp. CMC.S10628 ◽  
Author(s):  
Carl J. Pepine
Keyword(s):  
Quality Of Life ◽  
Atrial Fibrillation ◽  
Systematic Review ◽  
Elderly Patients ◽  
Randomized Trials ◽  
Rhythm Control ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related

This systematic review assessed the impact of atrial fibrillation (AF) and pharmacotherapy on health-related quality of life (HRQOL) in elderly patients. Highly prevalent in the elderly, AF is associated with morbidity and symptoms affecting HRQOL. A PubMed and EMBASE search (1999-2010) was conducted using the terms atrial fibrillation, elderly, quality of life, Medicare, and Medicaid. In all, 504 articles were identified and 15 were selected (studies examining pharmacotherapy [rate or rhythm control] and HRQOL in AF patients with a mean age > 65 years). Information, including study design, cohort size, and HRQOL instruments utilized, was extracted. Five observational studies, 5 randomized trials comparing rate and rhythm control, 3 randomized trials investigating pharmacologic agents, and 2 trials examining HRQOL, depression, and anxiety were identified. Elderly AF patients had reduced HRQOL versus patients in normal sinus rhythm, particularly in domains related to physical functioning. HRQOL may be particularly affected in older AF patients. Although data do not indicate whether a pharmacologic intervention or single treatment strategy—namely rate versus rhythm control—is better at improving HRQOL, either of these strategies and many pharmacologic interventions may improve HRQOL in elderly AF patients. Based on reviewed data, an algorithm is suggested to optimize HRQOL among elderly patients.

scholarly journals Health-related quality of life and distress in elderly vs. younger patients with high-grade glioma—results of a multicenter study

2020 ◽  
Vol 28 (11) ◽  
pp. 5165-5175 ◽  
Author(s):  
Mirjam Renovanz ◽  
Anne-Katrin Hickmann ◽  
Minou Nadji-Ohl ◽  
Naureen Keric ◽  
Elke Weimann ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Elderly Patients ◽  
High Grade Glioma ◽  
High Grade ◽  
Health Related Quality ◽  
Younger Patients ◽  
Patient Reported ◽  
Related Quality ◽  
Health Related

Abstract Objective Half of all newly diagnosed patients with glioblastoma are > 65 years still with a poor prognosis. Preserving quality of life is of high importance. However, patient reported outcome (PRO) data in this patient group is rare. The aim was to compare health-related quality of life (HRQoL) and distress between elderly and younger patients with high-grade glioma (HGG). Methods We used baseline data of a prospective study where HGG patients were enrolled from 4 hospitals. Distress was measured using the distress thermometer (DT), HRQoL using the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Core Questionnaire (QLQ-C30) plus brain module (BN20). We compared distress and HRQoL by age (≥ 65 vs. < 65 years), gender, performance score, and time since diagnosis using multivariate linear and logistic regressions. Results A total of n = 93 (30%) out of n = 309 patients were ≥ 65 years (mean 70 years, range 65–86 years). Mean DT score of elderly patients (5.2, SD 2.6) was comparable with younger patients (4.9, SD 2.6). Elderly patients reported significantly lower global health (GHS, mean elderly vs. younger; 50.8 vs. 60.5, p = 0.003), worse physical (56.8 vs. 73.3, p < 0.001) and lower cognitive functioning (51.1 vs. 63.2, p = 0.002), worse fatigue (52.5 vs. 43.5, p = 0.042), and worse motor dysfunction (34.9 vs. 23.6, p = 0.030). KPS and not age was consistently associated with HRQoL. Conclusion Physical functioning was significantly reduced in the elderly compared with younger HGG patients, and at the same time, emotional functioning and DT scores were comparable. KPS shows a greater association with HRQoL than with calendric age in HGG patients reflecting the particular importance for adequate assessment of HRQoL and general condition in elderly patients.

scholarly journals Are Sarcopenia and Myosteatosis in Elderly Patients with Pelvic Ring Injury Related to Mortality, Physical Functioning and Quality of Life?

2021 ◽  
Vol 10 (21) ◽  
pp. 4874
Author(s):  
Hester Banierink ◽  
Julia J. C. Bombach ◽  
Kaj ten Duis ◽  
Frank F. A. IJpma ◽  
Erik Heineman ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Risk Factors ◽  
Elderly Patients ◽  
Physical Functioning ◽  
Pelvic Ring ◽  
Cox Proportional Hazards ◽  
Pelvic Ring Injury ◽  
Cross Sectional ◽  
Patient Reported

The purpose of this study was to evaluate the prevalence of sarcopenia and/or myosteatosis in elderly patients with pelvic ring injuries and their influence on mortality, patient-perceived physical functioning and quality of life (QoL). A multicenter retrospective cohort study was conducted including elderly patients aged ≥ 65 treated for a pelvic ring injury. Cross-sectional computed tomography (CT) muscle measurements were obtained to determine the presence of sarcopenia and/or myosteatosis. Kaplan–Meier analysis was used for survival analysis, and Cox proportional hazards regression analysis was used to determine risk factors for mortality. Patient-reported outcome measures for physical functioning (SMFA) and QoL (EQ-5D) were used. Multivariable linear regression analyses were used to determine the effect of sarcopenia and myosteatosis on patient-perceived physical functioning and QoL. Data to determine sarcopenia and myosteatosis were available for 199 patients, with a mean follow-up of 2.4 ± 2.2 years: 66 patients (33%) were diagnosed with sarcopenia and 65 (32%) with myosteatosis, while 30 of them (15%) had both. Mortality rates in patients at 1 and 3 years without sarcopenia and myosteatosis were 13% and 21%, compared to 11% and 36% in patients with sarcopenia, 17% and 31% in patients with myosteatosis and 27% and 43% in patients with both. Higher age at the time of injury and a higher Charlson Comorbidity Index (CCI) were independent risk factors for mortality. Patient-reported mental and emotional problems were significantly increased in patients with sarcopenia.

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

Heart ◽  
2019 ◽  
Vol 105 (21) ◽  
pp. 1642-1648 ◽  
Author(s):  
Kelly Therese Gleason ◽  
Cheryl Renee Dennison Himmelfarb ◽  
Daniel Ernest Ford ◽  
Harold Lehmann ◽  
Laura Samuel ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Atrial Fibrillation ◽  
Functional Status ◽  
Rate Control ◽  
Symptom Severity ◽  
Patient Reported Outcomes ◽  
Patient Reported ◽  
Related Quality ◽  
The Impact

ObjectivesWomen 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.MethodsParticipants 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.ResultsOur 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).ConclusionsFemale 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.

scholarly journals Influence of a Structured Exercise Training on Patients Reported Quality of Life in Colorectal Cancer Patients After Adjuvant Chemotherapy: A Pilot Study

2020 ◽  
Vol 19 ◽  
pp. 153473542093845 ◽  
Author(s):  
Gudrun Piringer ◽  
Bernhard Holzner ◽  
Beate Mayrbaeurl ◽  
Sonja Heibl ◽  
Monika Sztankay ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Colorectal Cancer ◽  
Adjuvant Chemotherapy ◽  
Exercise Training ◽  
Emotional Functioning ◽  
Treatment Strategies ◽  
Patient Reported ◽  
Global Quality Of Life ◽  
Colorectal Cancer Patients

Purpose: Cancer and its treatment strategies can have adverse effects on physical functioning and quality of life. Treatment strategies for better quality of life are still an unresolved issue. Physical activity is a promising treatment strategy that still has to be fully investigated. Methods: The ABCSG C07-EXERCISE study evaluated the feasibility of a 1-year exercise training after adjuvant chemotherapy in colorectal cancer patients. The present report presents the patient-reported outcomes during the exercise training. Fourteen patients of one center filled out the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ C30) questionnaire at 5 time points after initiating a 1-year exercise training. Results: At baseline, patients scored social functioning, emotional functioning, financial impact, insomnia, and diarrhea much worse than the German general population. After 1 year of a structured exercise training, a large improvement was reported for social functioning; moderate improvements were reported for pain, diarrhea, financial impact, and taste; and a small change for physical and emotional functioning as well as for global quality of life. Conclusions: The present study observed improvements of social, physical, and emotional functioning as well as global quality of life after 1 year of a structured exercise training in patients with locally advanced colorectal cancer after receiving adjuvant chemotherapy. To enhance compliance, sufficient support and different sport facilities should be offered. The positive effect of exercise on patient-reported outcomes, disease-free survival, and overall survival in cancer survivors have to be further investigated in further randomized clinical trials.

Exercise Tolerance and Quality of Life in Elderly Patients with Chronic Atrial Fibrillation

2001 ◽  
Vol 6 (1) ◽  
pp. 23-29 ◽  
Author(s):  
Christopher J. Howes ◽  
M. Carrington Reid ◽  
Cynthia Brandt ◽  
Bernice Ruo ◽  
Michael W. Yerkey ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Atrial Fibrillation ◽  
Elderly Patients ◽  
Exercise Tolerance ◽  
Chronic Atrial Fibrillation

scholarly journals Heart Watch Study: protocol for a pragmatic randomised controlled trial

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e054550
Author(s):  
Sanket S Dhruva ◽  
Nilay D Shah ◽  
Sreekanth Vemulapalli ◽  
Abhishek Deshmukh ◽  
Alexis L Beatty ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Atrial Fibrillation ◽  
Heart Rate ◽  
Atrial Flutter ◽  
Healthcare Utilisation ◽  
Digital Devices ◽  
Patient Reported ◽  
Secondary Outcomes ◽  
The Impact

IntroductionPersonal digital devices that provide health information, such as the Apple Watch, have developed an increasing array of cardiopulmonary tracking features which have received regulatory clearance and are directly marketed to consumers. Despite their widespread and increasing use, data about the impact of personal digital device use on patient-reported outcomes and healthcare utilisation are sparse. Among a population of patients with atrial fibrillation and/or atrial flutter undergoing cardioversion, our primary aim is to determine the impact of the heart rate measurement, irregular rhythm notification, and ECG features of the Apple Watch on quality of life and healthcare utilisation.Methods and analysisWe are conducting a prospective, open-label multicentre pragmatic randomised clinical trial, leveraging a unique patient-centred health data sharing platform for enrolment and follow-up. A total of 150 patients undergoing cardioversion for atrial fibrillation or atrial flutter will be randomised 1:1 to receive the Apple Watch Series 6 or Withings Move at the time of cardioversion. The primary outcome is the difference in the Atrial Fibrillation Effect on QualiTy-of-life global score at 6 months postcardioversion. Secondary outcomes include inpatient and outpatient healthcare utilisation. Additional secondary outcomes include a comparison of the Apple Watch ECG and pulse oximeter features with gold-standard data obtained in routine clinical care settings.Ethics and disseminationThe Institutional Review Boards at Yale University, Mayo Clinic, and Duke University Health System have approved the trial protocol. This trial will provide important data to policymakers, clinicians and patients about the impact of the heart rate, irregular rhythm notification, and ECG features of widely used personal digital devices on patient quality of life and healthcare utilisation. Findings will be disseminated to study participants, at professional society meetings and in peer-reviewed journals.Trial registration numberNCT04468321

scholarly journals Feasibility Study Protocol: Investigating The Impact of Bleed Events On Anticoagulated Patients Diagnosed With Atrial Fibrillation Using Patient Reported Outcome Measures

2021 ◽  
Author(s):  
Hayley A Hutchings ◽  
Kirsty Lanyon ◽  
Steven Lister ◽  
Raza Alikhan ◽  
Claire Fegan ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Atrial Fibrillation ◽  
Outcome Measures ◽  
Major Bleeding ◽  
Structured Interview ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Patient Reported ◽  
The Impact

Abstract BackgroundAtrial fibrillation (AF) is the most common cardiac arrhythmia. Oral anticoagulation therapies (OATs) are often prescribed in conjunction with medications to restore normal heart rate rhythm which can limit the risk of an AF-related stroke and systemic thromboembolism. However, they are associated with the serious side effect of bleeding. Both clinically relevant non-major bleeding (CRNMB) and major bleeding while anticoagulated are believed to have a significant impact on patient quality of life (QoL). There is currently limited research into the effect bleeding has on QoL. The aim of this study is to evaluate the feasibility of identifying and recruiting patients diagnosed with AF, who are taking OATs and have recently experienced a bleed and collecting information on their QoL.MethodsWe will recruit a minimum of 50 patients to this cross sectional, observational study. We will recruit from general practices, secondary care and through an online AF forum. We will ask participants to complete three validated patient-reported outcome measures (PROMs: EQ5D, AFEQT and PACT-Q), approximately four weeks following a bleed and again 3 months later. We will randomly select a subset of 10 participants (of those who agree to be interviewed) to undergo a structured interview with a member of the research team to explore the impact of bleeding on their QoL and to gain feedback on the three PROMs used. We will undertake a descriptive analysis of the PROMs and demographic data. We will analyse the qualitative interviews thematically to identify key themes. DiscussionWe aim to establish if it is possible to recruit patients and use PROMs to collect information regarding how patient QoL is affected when they experience either a CRNMB or major bleed, while taking OATs for the management of AF. We will also explore the appropriateness or otherwise of the three identified PROMs for assessing quality of life following a bleed. Trial registrationThe trial has been adopted onto the NIHR Portfolio (I.D. #47771) and registered with www.ClinicalTrials.gov (#NCT04921176) retrospectively registered in June 2021.

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