scholarly journals Atrial fibrillation burden, episode duration and frequency in relation to quality of life in patients with implantable cardiac monitor

2021 ◽  
Vol 34 ◽  
pp. 100791
Author(s):  
Victoria Jansson ◽  
Lennart Bergfeldt ◽  
Jonas Schwieler ◽  
Göran Kennebäck ◽  
Aigars Rubulis ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Atrial Fibrillation ◽  
Cardiac Monitor ◽  
Episode Duration ◽  
Atrial Fibrillation Burden ◽  
Implantable Cardiac Monitor

Relationship between quality of life and burden of recurrent atrial fibrillation following ablation: CAPCOST multicentre cohort study

EP Europace ◽  
2020 ◽  
Vol 22 (7) ◽  
pp. 1017-1025
Author(s):  
Vidal Essebag ◽  
Zahra Azizi ◽  
Pouria Alipour ◽  
Yaariv Khaykin ◽  
Peter Leong-Sit ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Atrial Fibrillation ◽  
Short Form ◽  
Total Duration ◽  
Clinical Trial Registration ◽  
Point Change ◽  
Af Ablation ◽  
Recurrent Atrial Fibrillation ◽  
Atrial Fibrillation Burden

Abstract Aims Atrial fibrillation (AF) significantly impairs patients’ quality of life (QOL). We performed this study to investigate the effect of AF-ablation success and atrial fibrillation burden (AFB) on QOL measures. Methods and results Overall, 230 patients with paroxysmal AF refractory to antiarrhythmic drugs were enrolled and underwent ablation in a multicentre, prospective cohort. Electrocardiogram, 48-h Holter, Canadian Cardiovascular Society Severity of Atrial Fibrillation (CCS-SAF), short form-12 (SF-12), and Atrial Fibrillation Effect on Quality of life (AFEQT) scales were used to assess patients. Atrial fibrillation burden was defined as total duration of AF during the month prior to each visit (h/month). The change in AFB was calculated as the difference between the month prior to the 12-month post-ablation and the baseline pre-ablation. The Minimal Clinically Important Difference (MCID) was considered as a 19-point change for AFEQT and 3–5-point change for SF-12 scores. There was significant rise in the AFEQT and SF12 and decrease in CCS-SAF score post-AF ablation; however, the magnitude of these changes was greater in patients without AF recurrence (P < 0.05). The QOL score that best differentiated patients with and without recurrence was AFEQT, while, CCS-SAF was the most specific score. Patients with AFB decrease >19 h/month had significantly greater change in QOL scores. Atrial fibrillation burden < 24 h/month at 12-months post-ablation was associated with significant changes in QOL and CCS-SAF when adjusting for baseline scores and other covariates. These changes were consistent with the MCID of these measures. Conclusion Patients experience significant improvements in QOL post-ablation, which correlate with a decrease in AFB despite ongoing brief recurrences of AF. Clinical Trial Registration NCT01562912. https://www.clinicaltrials.gov/ct2/show/NCT01562912? term=capcost&rank=1

Abstract 14: Use of an Insertable Cardiac Monitor to Detect Atrial Fibrillation is Cost Effective in Patients with Cryptogenic Stroke

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Alex Diamantopoulos ◽  
Laura Sawyer ◽  
Dilpreet Sungher ◽  
Gregory Lip ◽  
Klaus Witte ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Atrial Fibrillation ◽  
Cost Effectiveness ◽  
Recurrent Stroke ◽  
Cryptogenic Stroke ◽  
Cost Effective ◽  
Cardiac Monitor ◽  
The Uk ◽  
Insertable Cardiac Monitor

Introduction: The cause of ischemic stroke remains uncertain (cryptogenic stroke) in 20-40% of cases despite conventional diagnostic tests. Documentation of atrial fibrillation (AF) is required to initiate anticoagulant therapy to reduce recurrent stroke risk, however, the paroxysmal and asymptomatic nature of AF means it is often not detected with traditional monitoring techniques. We assessed the hypothesis that detecting AF via continuous long-term monitoring with an insertable cardiac monitor (ICM) is cost effective for preventing recurrent stroke in cryptogenic stroke patients, in comparison to Standard of Care (SoC). Methods: A randomized controlled trial reported a nine-fold increase in AF detection with an ICM (Reveal XT, Medtronic) compared to SoC over 3 years follow-up, after exclusion of patients with evidence of AF from initial tests. A lifetime Markov model was developed which uses trial data to estimate cost effectiveness of ICM from a U.K. NHS perspective. The CRYSTAL AF study provided AF detection rates, ICM implant complications, resource use and baseline quality of life. Safety and efficacy data for specific non-vitamin K antagonist oral anticoagulants (NOACs) and warfarin were sourced from literature to estimate stroke and bleeding risks. Other quality of life and cost data were sourced mainly from the UK OXVASC study. All costs and benefits were discounted at 3.5% and scenario analyses (CHADS2 score) and probabilistic sensitivity analyses (PSA) were conducted. Results: ICM was associated with fewer recurrent strokes and increased Quality Adjusted Life Years (QALYs) compared to SoC. Stroke-related costs were reduced in the ICM arm, however, overall costs did remain higher than SoC. The incremental cost-effectiveness ratio (ICER) was below a £30,000 per QALY gained willingness-to-pay threshold. Sensitivity analysis indicated that the ICER increased in patients with lower CHADS2 scores, however, it remained below the threshold. Conclusion: AF detection with ICM increases linearly over its 3 year life, identifying AF in nine-fold more patients than SoC. ICM appears to be a cost-effective diagnostic tool for the prevention of recurrent stroke in patients with cryptogenic stroke in the UK and countries with similar healthcare systems.

Anxiety-depressive disorders and quality of life in patients with atrial fibrillation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Demenko ◽  
G.A Chumakova
Keyword(s):  
Quality Of Life ◽  
Physical Activity ◽  
Atrial Fibrillation ◽  
Correlation Analysis ◽  
Depressive Disorders ◽  
Life Assessment ◽  
Mild Depression ◽  
Group 2 ◽  
Group 1

Abstract Background Mental disorders in patients with cardiovascular disease have a significant impact on the course, the prognosis of the underlying disease and quality of life (QOL). Objective We aimed to examine the prevalence of anxiety and depressive disorders and their impact on the quality of life in patients with atrial fibrillation (AF). Materials and methods In 52 with permanent AF and 50 with paroxysmal AF patients, we administered the depression scale Tsung, the scale of situational anxiety (SA) and personal anxiety (PA) Spielberger-Hanin; QOL was assessed the SF-36 quality of life assessment scale. Correlation analysis using Spearman's rank correlation coefficient. Results The prevalence symptoms mild depression situational or neurotic genesis was 21.1% (12 patients) in Group 1 and 12.0% (6 patients) in Group 2 (p>0.05). Subdepressive state was two percents of patients in Group 1 and Group 2. The incidence SA was 59.6% (31 patients) in Group 1 and 52.0% (26 patients) in Group 2. The incidence PA was 74.0% (37 patients) in Group 2 and 67.3% (35 patients) in Group 1. The average score the physical component of health (PCH) was 29,8±4,3 in Group 1, the mental component of health (MCH) – 49.5±7.4 points; p<0.05. In Group 2: PCH – 44.8±6.6 points, MCH – 26.6±7.5 points; p<0.05. Correlation analysis showed negative strong correlations between SA and MCH (r=−0.64, p=0.0005) and between PA and MCH (r=−0.69, p<0.0001), between SA and PCH (r=−0.71, p=0.0001), between depression and PCH (r=−0.69, p=0.023). Negative statistically significant correlation between depression and MCH (r=−0.69, p=0.54) and negative medium correlation between depression and PCH (r=−0.64, p=0.23). Conclusion These findings suggest that we did not identify patients with symptoms of a true depressive (that can cause pseudodementia and influenced to complete tests). 16.5% patients with AF had mild depression of situational or neurotic genesis. Depression may be a pathogenetic factor of AF or develop because of paroxysms AF – psychological stress. More than 50% patients in Group 1 and Group 2 had an increased anxiety score. SA is more common in patients with permanent AF, probably because older people difficult to adapt to a new situation. PA is more common in patient with paroxysmal AF, probably because disease is sudden and causes anxiety. The PCH of QOL is more impairment in patients with permanent AF, because complications (for example heart failure) impairment physical activity. However, PCH also reduced in patient with paroxysmal AF, because disease is sudden may occur during physical activity. The MCH of QOL is more impairment in patients with paroxysmal AF, because waiting attack effect on mental health and social functioning. An increased level of anxiety and depression negatively affected the mental and physical health of patients with AF. Funding Acknowledgement Type of funding source: None

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