Abstract 15773: Differences in Atrial Fibrillation Symptoms, Quality of Life, and Response to Therapy Across Race-ethnicity

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Yining Chen ◽  
Mary Carolina Rodriguez Ziccardi ◽  
Aylin Ornelas ◽  
Faisal Darbar ◽  
Zain Alzahrani ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Atrial Fibrillation ◽  
Rate Control ◽  
Rhythm Control ◽  
Response To Therapy ◽  
Clinical Genetic ◽  
Control Versus ◽  
Race Ethnicity ◽  
Control Therapy

Introduction: Atrial fibrillation (AF) guidelines are heavily predicated on assessing the severity of symptoms experienced by individual patients when selecting either rate or rhythm control strategy. While the severity of symptoms can be highly variable, it remains unclear if race-ethnicity influences AF symptoms and quality-of-life (QoL). We sought to determine whether race-ethnicity modulates severity of AF symptoms, QoL and response to therapy. Methods: A prospective cohort study of 415 patients diagnosed with new-onset AF enrolled over a 30-month period in a clinical-genetic registry. Baseline assessment of patients prior to treatment initiation included a detailed patient history and the validated 20-item Atrial Fibrillation Effect on QualiTy-of-life (AFEQT) questionnaire. We divided the cohort into groups based on race-ethnicity (African American[AA], European American[EA], Hispanic/Latino[H/L]) and treatment strategy (rate or rhythm control). Results: Of 306 consecutive patients with AF, 113 (36.9%) were AA, 108 (35.3%) EA and 85 (27.8%) H/L. The mean age was 61.9±13.0 years, and 105 (34.3%) were female with 154 (50.3%) patients treated with rate control versus 152 (49.7%) with rhythm control therapy. Both AA (52.1%) and H/L (65.9%) patients were more likely to be initiated on rate control therapy as compared with EAs (36.1%; P=0.0002) despite lower baseline AFEQT scores (AA: 72.9.9±23.2; H/L: 75.1±20.7; and EA: 80.2±17.9; P=0.24) and greater impairment of QoL. The overall AFEQT scores and QoL improved significantly in AAs (Δscore: 10.4±28.2; P<0.0001) and EAs (Δscore: 11.9±20.1; P<0.0001) and was mostly associated with improvement in activities of daily living. Multivariate predictors of improvement in QoL in patients with AF included not only rhythm control therapy but also a history of both coronary artery disease and obesity. Conclusion: The severity and perception of AF symptoms is highly variable in individual patients. Our study showed that ethnic minorities with AF are more likely to receive rate control therapy when compared to patients of European descent despite poorer QoL. Our findings may have important clinical implications for the assessment of symptoms and management of AF in AAs and H/Ls.

Differences in Atrial Fibrillation Symptoms and Quality of Life and Response to Therapy Across Race-Ethnicity

2021 ◽  
Author(s):  
Mary Rodriguez Ziccardi ◽  
bahaa Al-Azzam ◽  
Yining Chen ◽  
Faisal Darbar ◽  
Aylin Ornelas-Loredo ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Atrial Fibrillation ◽  
Response To Therapy ◽  
Race Ethnicity

scholarly journals B-PO03-080 DIFFERENCES IN ATRIAL FIBRILLATION SYMPTOMS, QUALITY OF LIFE, AND RESPONSE TO THERAPY ACROSS RACE-ETHNICITY

Heart Rhythm ◽  
2021 ◽  
Vol 18 (8) ◽  
pp. S221
Author(s):  
Mary Carolina Rodriguez Ziccardi ◽  
Yining Chen Faisal Darbar ◽  
Aylin Ornelas-Loredo, Vivek Mehta ◽  
Baha'a Al-Azzam ◽  
Aamir Twing ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Atrial Fibrillation ◽  
Response To Therapy ◽  
Race Ethnicity

scholarly journals Cabins, castles, and constant hearts: rhythm control therapy in patients with atrial fibrillation

2019 ◽  
Vol 40 (46) ◽  
pp. 3793-3799c ◽  
Author(s):  
Stephan Willems ◽  
Christian Meyer ◽  
Joseph de Bono ◽  
Axel Brandes ◽  
Lars Eckardt ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Left Ventricular Function ◽  
Antiarrhythmic Drugs ◽  
Left Ventricular ◽  
Rhythm Control ◽  
Af Ablation ◽  
Control Therapy

Abstract Recent innovations have the potential to improve rhythm control therapy in patients with atrial fibrillation (AF). Controlled trials provide new evidence on the effectiveness and safety of rhythm control therapy, particularly in patients with AF and heart failure. This review summarizes evidence supporting the use of rhythm control therapy in patients with AF for different outcomes, discusses implications for indications, and highlights remaining clinical gaps in evidence. Rhythm control therapy improves symptoms and quality of life in patients with symptomatic AF and can be safely delivered in elderly patients with comorbidities (mean age 70 years, 3–7% complications at 1 year). Atrial fibrillation ablation maintains sinus rhythm more effectively than antiarrhythmic drug therapy, but recurrent AF remains common, highlighting the need for better patient selection (precision medicine). Antiarrhythmic drugs remain effective after AF ablation, underpinning the synergistic mechanisms of action of AF ablation and antiarrhythmic drugs. Atrial fibrillation ablation appears to improve left ventricular function in a subset of patients with AF and heart failure. Data on the prognostic effect of rhythm control therapy are heterogeneous without a clear signal for either benefit or harm. Rhythm control therapy has acceptable safety and improves quality of life in patients with symptomatic AF, including in elderly populations with stroke risk factors. There is a clinical need to better stratify patients for rhythm control therapy. Further studies are needed to determine whether rhythm control therapy, and particularly AF ablation, improves left ventricular function and reduces AF-related complications.

scholarly journals Atrial fibrillation with high ventricular rate in emergency room: What’s the best strategy for treatment?

2016 ◽  
Vol 62 (9) ◽  
pp. 879-885 ◽  
Author(s):  
ALEXANDRE DE MATOS SOEIRO ◽  
TATIANA DE CARVALHO ANDREUCCI TORRES LEAL ◽  
MARIA CAROLINA FERES DE ALMEIDA SOEIRO ◽  
CARLOS VICENTE SERRANO JR. ◽  
MÚCIO TAVARES OLIVEIRA JR.
Keyword(s):  
Quality Of Life ◽  
Atrial Fibrillation ◽  
Heart Rate ◽  
Structural Heart Disease ◽  
Rhythm Control ◽  
Significant Decline ◽  
Ventricular Rate ◽  
Ventricular Response ◽  
Control Therapy

SUMMARY Atrial fibrillation (AF) is the most common arrhythmia in clinical practice and can lead to significant decline in functional status and quality of life among affected patients. The risk of developing AF increases with age and the presence of structural heart disease. Thus, the attendance of patients with high ventricular response to AF is common, which makes knowledge of its management mandatory. In this context, the choice of heart rate and/or rhythm control therapy is fundamental and complex, with multiple possibilities. Thus, this review aims to assist in the management of these patients, systematizing their care.

scholarly journals Rate-control vs rhythm-control of atrial fibrillation in elderly patients. From new, age-oriented outcomes to a more complex management strategy

2018 ◽  
Vol 88 (2) ◽  
Author(s):  
Stefano Fumagalli ◽  
Serena Boni ◽  
Simone Pupo ◽  
Marta Migliorini ◽  
Irene Marozzi ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Control Strategy ◽  
Rate Control ◽  
The Elderly ◽  
Epidemiological Studies ◽  
Rhythm Control ◽  
Aged Patients ◽  
Aged People ◽  
Arrhythmia Management

Atrial fibrillation (AF) is the most frequent arrhythmia in elderly people. Findings derived from clinical trials seem to demonstrate that a rate-control strategy of AF in aged patients improves prognosis if compared to a rhythm-control one. However, epidemiological studies concordantly show that the arrhythmia is associated to increased hospitalization and mortality rates. In last years, the proportion of patients admitted to hospital for AF has progressively increased; this trend is observed in subjects >75 and >85 years, while no change was found in younger cohorts. Importantly, in aged individuals, probably because of the loss of atrial activity, the increase of heart rate and the irregularity of RR intervals, AF begins a vicious cycle, leading from heart failure, through the compromise of functional and neurocognitive status, to overt disability, dementia and increased mortality. Evidence specifically aimed at clarifying the effects of arrhythmia management on outcomes characteristic of aged people is completely lacking. In the elderly, the question regarding the effects of a rate- or a rhythm-control strategy of AF should be considered as an aspect of a more complex strategy, addressed to reduce disability and hospitalizations, and to improve quality of life and survival.

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.

Vorhofflimmern: Wie wichtig ist der Erhalt des Sinusrhythmus?

2020 ◽  
Vol 145 (08) ◽  
pp. 543-549
Author(s):  
Christian Meyer ◽  
Andreas Metzner ◽  
Paulus Kirchhof
Keyword(s):  
Quality Of Life ◽  
Antiarrhythmic Drugs ◽  
Pulmonary Veins ◽  
Left Ventricular ◽  
Rhythm Control ◽  
Af Ablation ◽  
Stroke Risk Factors ◽  
Control Therapy ◽  
Rhythm Stability

AbstractRhythm control therapy, comprising antiarrhythmic drugs, cardioversion, and AF ablation, is an important component in the management of patients with atrial fibrillation (AF). Catheter ablation for AF, mainly targeting isolation of the pulmonary veins (AF ablation), has markedly improved the effectiveness of rhythm control therapy. Rhythm control improves symptoms and quality of life in patients with symptomatic AF. AF ablation maintains sinus rhythm more effectively than antiarrhythmic drug therapy. Antiarrhythmic drugs remain effective after AF ablation, underpinning the synergistic mechanisms of action of AF ablation and antiarrhythmic drugs. Different lifestyle interventions might additionally improve symptoms and rhythm stability in patients with AF. AF ablation appears to improve left ventricular function in a subset of patients. Summarized, rhythm control therapy in patients with symptomatic AF is safe and improves quality of life, including elderly patients with stroke risk factors. Further studies are needed to determine whether rhythm control therapy reduces AF-related complications while improving patient outcome with regard to prognosis.

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