Quality of life in older people with atrial fibrillation

This review summarises the literature on quality of life in patients with atrial fibrillation. Since atrial fibrillation is predominantly a disease of maturity, the majority of studies examining quality of life in this patient population have been conducted in older adults people (aged ≥65 years). Almost all studies have demonstrated poorer quality of life among patients with atrial fibrillation compared to age-matched general populations. Rate-control and rhythm-control strategies in highly symptomatic patients have revealed significant improvements in quality of life following the interventions, presumably as a result of the immediate relief of symptoms. Further, randomised controlled trials of rate- versus rhythm-control strategies have shown that some aspects of quality of life improve significantly following either intervention and that neither rate nor rhythm-control is superior in increasing quality of life. Control of the heart rate, rather than restoring sinus rhythm, appears to be associated with better quality of life in more domains.     

The relationship between atrial fibrillation and frailty in community-dwelling older adults

Objectives(1) To compare the frailty status between community-dwelling older adults with and without atrial fibrillation (AF) in Taiwan and (2) to test the hypothesis that AF is associated with frailty in community-dwelling older adults.MethodsWe conducted a cross-sectional study in several communities in Taipei. AF was confirmed by electrocardiogram recordings or medical diagnosis. Frailty status was assessed using both the Cardiovascular Health Study (CHS) frailty phenotype and Edmonton Frail Scale (EFS).ResultsA total of 207 community-dwelling older adults voluntarily participated in this study, and 38 had AF. There was a significantly higher percentage of frailer (prefrail and frailty) older adults in the AF group (69 % vs. 36 %, p < 0.001) according to CHS phenotype, but no significant difference was detected by EFS criteria (92 % vs. 92 %, p = 0.966). The AF group showed significantly lower grip strength in men (26.8 ± 8.3 vs. 33.0 ± 6.9 kg, p = 0.006), walking speed (1.1 ± 0.3 vs. 1.2 ± 0.3 m/s, p = 0.003), and Timed Up and Go performance (8.8 ± 2.4 vs. 7.0 ± 1.9 s, p < 0.001) than the control group. The multiple logistic regression model showed that AF was an independent factor associated with frailer community-dwelling older adults after adjusted for covariates (odds ratio, 3.02; 95 % confidence interval, 1.32–6.89, p = 0.009).ConclusionCommunity-dwelling older adults with AF showed a significantly higher percentage of frailer individuals and lower physical function than those without AF. Furthermore, AF was an independent predictor of frailer community-dwelling older adults.     

Effects of Playback Theatre on cognitive function and quality of life in older adults in Singapore: A preliminary study

Objective

This study investigated the effects of Playback Theatre on older adults’ cognitive function and well‐being, specifically in the Singapore context.

Methods

Eighteen healthy older adults, older than 50 years of age, participated in the study. Due to practical limitations, a single‐group pre–post study design was adopted. Participants completed the outcome measures before and after the training program. There were six weekly sessions in total (about 1.5 hours, once weekly).

Results

Participants experienced a significant improvement in their emotional well‐being after training. However, there were no significant changes in participants’ cognitive function or health‐related quality of life.

Conclusion

Our results suggest that Playback Theatre as a community program has potential to improve the mental and emotional well‐being of older people.     

Impact of obesity on catheter ablation of atrial fibrillation: Patient characteristics,procedural complications,outcomes, and quality of life

Introduction

Obesity is a well-known risk factor for atrial fibrillation (AF). We aim to evaluate the effect of baseline obesity on procedural complications, AF recurrence, and symptoms following catheter ablation (CA).

Methods

All consecutive patients undergoing AF ablation (2013–2021) at our center were enrolled in a prospective registry. The study included all consecutive patients with available data on body mass index (BMI). Primary endpoint was AF recurrence based on electrocardiographic documentation. Patients were categorized into five groups according to their baseline BMI. Patients survey at baseline and at follow-up were used to calculate AF symptom severity score (AFSS) as well as AF burden (mean of AF duration score and AF frequency score; scale 0: no AF to 10: continuous and 9 frequencies/durations in between). Patients were scheduled for follow-up visits with 12-lead electrocardiogram at 3, 6, and 12 months after ablation, and every 6 months thereafter.

Results

A total of 5841 patients were included (17% normal weight, 34% overweight, 27% Class I, 13% Class II, and 9% Class III obesity). Major procedural complications were low (1.5%) among all BMI subgroups. At 3 years AF recurrence was the highest in Class III obesity patients (48%) followed by Class II (43%), whereas Class I, normal, and overweight had similar results with lower recurrence (35%). In multivariable analyses, Class III obesity (BMI ≥ 40) was independently associated with increased risk for AF recurrence (hazard ratio, 1.30; confidence interval, 1.06–1.60; p = .01), whereas other groups had similar risk in comparison to normal weight. Baseline AFSS was lowest in normal weight, and highest in Obesity-III, median (interquartile range) 10 (5–16) versus 15 (10–21). In all groups, CA resulted in a significant improvement in their AFSS with a similar magnitude among the groups. At follow-up, AF burden was minimal and did not differ significantly between the groups.

Conclusion

AF ablation is safe with a low complication rate across all BMI groups. Morbid obesity (BMI ≥ 40) was significantly associated with reduced AF ablation success. However, ablation resulted in improvement in QoL including reduction of the AFSS, and AF burden regardless of BMI.     

Effects of different interventions on prognosis and quality of life in patients with atrial fibrillation

Objective

To compare the effects of different intervention measures on prognosis and quality of life in patients with atrial fibrillation, in order to provide clinical basis for diagnosis and treatment.

Methods

A total of 160 patients who visited several hospitals including Shanghai Xinhua Hospital from June 2019 to June 2021 were selected. Among them, 40 cases were in the drug treatment group (DRUG group), 40 cases in the radiofrequency ablation group (Radiofrequency ablation, RFA group), and 40 cases in the catheter ablation combined with percutaneous left atrial appendage occlusion group (“"one-stop”" procedure group) and 40 cases in the percutaneous left atrial appendage closure group (Left atrial appendage closure, LAAC group). The Minnesota quality of life score (MLHFQ), ejection fraction (LVEF), and left atrial anterior and posterior diameters (LAD) were compared between the groups at 1-year follow-up, and the differences in adverse events were compared between the groups.

Results

(1) After a 1-year follow-up, overall comparison, the MLHFQ scores and the LVEF and the LAD among the four groups were statistically different (p < .01); (2) Multiple comparisons, ① the MLHFQ scores: The RFA group was the lowest, the “one-stop” operation group was lower than the DRUG group, the LAAC group was the highest (p < .01). ② LVEF: The RFA group was the highest, the “one-stop” procedure group was higher than the drug treatment group, the LAAC group was the lowest (p < .01). ③ LAD: the RFA group and the “one-stop” procedure group were smaller than the DRUG group, the DRUG group was smaller than the LAAC group (p < .01).(3) Compared with the baseline data after 1-year follow-up in each group, in the RFA group and in the “one-stop” procedure group, the MLHFQ scores was decreased, the LVEF was increased, and the LAD was decreased (p < .01); in the DRUG group: the difference was not statistically significant (p > .05); in the LAAC group, the MLHFQ scores was increased, the LVEF was decreased, and the LAD was increased (p < .01). (4) There were significant differences in the incidence of adverse events among the four groups (p < .01), the lowest in the RFA group and the highest in the LAAC group.

Conclusion

Compared with drug treatment, radiofrequency ablation and “one-stop” procedure group can improve the quality of life of patients with atrial fibrillation, improve cardiac function, and reduce the occurrence of adverse events. Percutaneous left atrial appendage occlusion affects patients' quality of life and improves cardiac function, and increases the incidence of adverse events.     

Socio-demographics,spirituality, and quality of life among community-dwelling and institutionalized older adults: A structural equation model

PurposeThe increasing life expectancy of the population prompts an array of health conditions that impair an older adults’ quality of life (QoL). Although demographics and spirituality have been associated with QoL, limited literature elucidated the exact mechanisms of their interactions, especially in a culturally-diverse country like Philippines. Hence, this study determined the relationship among socio-demographics, spirituality, and QoL of Filipino older adults in a community and institutional setting.Materials and methodsA predictive-correlational study among 200 randomly-selected community-dwelling and institutionalized older adults was conducted, with a 99% power and a medium effect size. Data were collected using a three-part questionnaire from September to November 2015. The questionnaire was composed of the robotfoto, Spirituality Assessment Scale, and modified Older People’s Quality of Life which assessed socio-demographics, spirituality, and QoL.ResultsAnalysis showed that institutionalization in a nursing home positively and negatively affected spirituality and QoL, generating an acceptable model (χ²/df = 2.12, RMSEA = 0.08, and CFI = 0.95). The negative direct effect of institutionalization on social relationship, leisure, & social activities QoL (β=–0.42, p < 0.01) also initiates a cascade of indirect negative effects on both spirituality and QoL dimensions.ConclusionsThe development of a structural model illustrating the interrelationship of socio-demographics, spirituality, and QoL helps healthcare professionals in predicting facets of spirituality and QoL that can be compromised by living in a nursing home. This understanding provides impetus in evaluating and refining geriatric healthcare programs, policies, and protocols to render individualized, holistic care in a socially-cohesive environment among older adults.     

Prospective assessment of short- and long-term quality of life after ablation for atrial fibrillation

Quality of Life After Ablation for Atrial Fibrillation. Background : This study prospectively assesses different aspects of short‐ and long‐term quality of life (QoL) after catheter ablation for atrial fibrillation (AF). An analysis of 7 validated generic and tailored questionnaires was performed with regard to the relation of QoL to ablation success. Methods : The study included 133 patients (74% men, age 57±10) who underwent pulmonary vein isolation ± linear or electrogram‐guided substrate modification for AF. QoL was quantitatively assessed at baseline, 3 months after ablation and at a median of 4.3 ± 0.5 years after ablation by the AF severity scale (AFSS), AF symptom checklist (AFSC), WHO‐5‐Well‐Being‐Index (WHO), Major Depression Inventory (MDI), Sleep and Vegetative disorder (SV), Vital Exhaustion (VE), and Illness intrusiveness (Ii). Results: QoL was improved significantly 3 months after ablation in all patients (regardless of ablation success or AF type) and stayed significantly improved after a median of 4.3±0.5 years (AFSS, AFSC, WHO, MDI, VE, PE (all P < 0.001), and SV (P = 0.007)). Patients who had a successful ablation improved significantly more than patients with an unsuccessful ablation in the AFSS, AFSC, and MDI questionnaire (delta change from baseline to long‐term follow‐up P = <0.001, P = <0.001, and P = 0.039, respectively). Conclusion: Overall, all patients significantly improved their QoL irrespective of the AF type in all questionnaires 3 months and 4 years after ablation. The increase in QoL was significantly greater in patients who underwent a successful ablation than patients with unsuccessful ablation in the AFSS, AFSC, and MDI questionnaire. Cardiovasc Electrophysiol, Vol. 23, pp. 121‐127, February 2012)     

Components and determinants of quality of life in community-dwelling older adults

The objectives of this study are to detect the main components of global quality of life (QoL) of community-dwelling older adults from their own perspective and to identify determinants of health-related and global QoL in the same population. This is a cross-sectional study covering a representative sample of 1,106 community-dwelling adults aged 60 years and older residing in Spain. The survey collected information on QoL through a face-to-face interview asking for QoL components in free-format, as well as the completion of two QoL measures, the EQ-5D and the Personal Wellbeing Index. The most important QoL dimensions, according to the participants of this study, were health, family, and finances. Depression was the main determinant of both QoL indices, while functional independence and social support specifically influenced health-related and global QoL, respectively. Based on the perspective of the older adults as well as on statistical analysis, this work emphasizes the importance of health, family, and social support as areas of special interest in aging. There was a discrepancy when comparing findings related to the importance of financial status. Results also support that global and health-related QoL share some common determinants, but with different weights for functional independence and social support.     

Quality of life in atrial fibrillation: measurement tools and impact of interventions

Quality of life (QoL) is of central importance in atrial fibrillation as both a treatment goal and an endpoint in the evaluation of new therapies. QoL appears to be impaired in the majority of patients with AF. A number of interventions for AF have been shown to improve QoL, including pharmacologic and nonpharmacologic rate control, antiarrhythmic drugs, and nonpharmacologic rhythm control strategies. This paper will review the rationale, design, strengths, and limitations of the questionnaires most commonly used to assess QoL in AF studies, and present QoL outcomes from major studies of AF interventions.     

A supervised exercise intervention fails to improve depressive symptoms and quality of life among sedentary older adults with HIV infection

ABSTRACT

Older people living with HIV (PLWH) experience multimorbidity that can negatively impact quality of life (QoL). Exercise can improve physical function, but effects on QoL are not well understood. 32 PLWH and 37 controls aged 50–75 completed 12-weeks of moderate-intensity exercise, then were randomized to moderate or high-intensity for 12 additional weeks. Depressive symptoms (CES-D scores) were significantly greater and QOL (SF-36 mental and physical summary scores) significantly lower among PLWH at baseline (all p?<?0.05). PLWH had significantly greater worsening in CES-D scores compared to controls (3.4 [0.7, 6.0]; p?=?0.01) between 13and 24 weeks. Mental QoL changed minimally, with no significant difference in changes by serostatus between weeks 0 and 12 or weeks 13 and 24 (p?≤?0.22). Changes in physical function summary scores were similar by serostatus between 0 and 12 weeks (1.5 [?1.6, 4.6], p?=?0.35), but declined significantly more among PLWH between 13 and 24 weeks (?4.1 [?7.2,?1], p?=?0.01). Exercise intensity had no significant effect on changes in CES-D or SF-36 summary scores; high-intensity exercise was associated with greater improvements in vitality/fatigue (4.1 [0.8, 7.3], p?=?0.02), compared to moderate-intensity. Exercise initiation failed to improve depressive symptoms or QoL among PLWH. Additional interventions may be needed to maximize these patient-reported outcomes among older PLWH initiating an exercise program.     

Quality of life of older adults in Turkey

The purpose of this study was to examine the factors affecting the quality of life of the elderly people in Turkey. Three-hundred community-dwelling older adults (Mage = 68.35, SD = 5.80 years) participated in this study. The quality of life was examined through World Health Organization Quality of Life Questionnaire-Older Adults Module Turkish Version (WHOQOL-OLD Turkish).     

慢性心房颤动患者射频消融术后生活质量及临床症状变化

目的 通过观察患者生活质量和临床症状的变化来探讨射频消融术治疗慢性心房颤动(atrialfibrillation,AF)的疗效.方法 41例慢性AF患者接受经导管射频消融术,于术前3 d内和术后3个月用SF-36量表及症状列表评估患者生活质量和症状严重程度.结果 41例慢性AF患者接受射频消融术治疗,随访时间178 d～515 d,36例顺利完成随访并按消融术效果分为成功组(23例)和复发组(13例).射频消融术后3个月的生活质量评分与术前比较,躯体功能、躯体角色、社会功能、情感角色和精力有明显提高(P<0.05),而肌体疼痛、心理健康和总的健康状况方面差异无统计学意义(P>0.05).术后3个月的临床症状评分与术前比较,心悸与心动过速症状减轻,而呼吸困难、胸痛、头昏和活动受限变化差异无统计学意义.从治疗结果 分析,成功组和总体改变一致,而复发组虽然心悸和心动过速症状减轻,但在生活质量的8个维度评分变化差异无统计学意义(P>0.05).结论 慢性AF患者接受导管射频消融术后可以减轻症状,改善生活质量.     

Incident atrial fibrillation and mortality in older adults with heart failure

We studied 944 hospitalized heart failure patients 65 years and older to examine the impact of incident atrial fibrillation on mortality. Patients were categorized into four groups based on past medical history and admission electrocardiogram: (1) no (neither past nor current), (2) incident (newly diagnosed), (3) past and (4) chronic (past and current) atrial fibrillation. The primary outcome was 4-year all-cause mortality. Bivariate and multivariable Cox proportion hazards analyses were used to determine risk of all-cause mortality. In the multivariable model, we adjusted for various demographic and clinical covariates. Compared with patients who never had atrial fibrillation, those with incident atrial fibrillation had a 57% higher risk of death (unadjusted hazard ratio, 1.57; 95% confidence interval, 1.22-2.03). After adjustment for other covariates the association remained unchanged (adjusted hazard ratio, 1.41; 95% confidence interval, 1.08-1.83). Past or chronic atrial fibrillation was not associated with increased risk of death.