What is the clinical evidence from this study?

Study design: Cohort. Population: Atrial fibrillation (n=953). Intervention: Female sex vs. Male sex. Primary outcome: Functional status (β -2.23, 95% CI -3.52, -0.94).

April 5, 2019Open Access

Association of sex, age and education level with patient reported outcomes in atrial fibrillation

Key Result

Women reported significantly poorer functional status (β -2.23) and AF-related quality of life (β -4.12) compared to men with atrial fibrillation.

Study Design

Type

Cohort (n=953)

Multicenter

Yes

Structured PICO

Population

953 participants with an atrial fibrillation (AF) diagnosis and age ≥ 18 years across 4 academic medical centers

Outcome

Patient-reported outcomes including AF-related quality of life, symptom severity, and emotional and functional statuspatient reported

In patients with atrial fibrillation, women, younger adults (<60 years), and those with lower education levels experience significantly worse patient-reported outcomes, including lower quality of life and higher symptom burden.

Main Result

Effect estimate: β -2.23 (95% CI -3.52, -0.94)

Limitations

Voluntary participation leading to potential selection and reporting biases
Overwhelmingly white study sample (93%) limits generalizability
Did not measure prior physical activity, which may affect AF risk and experience
Reliance on electronic medical record data may miss diagnoses or medication changes from outside health systems

Abstract

BACKGROUND: In atrial fibrillation (AF), there are known sex and sociodemographic disparities in clinical outcomes such as stroke. We investigate whether disparities also exist with respect to patient-reported outcomes. We explored the association of sex, age, and education level with patient-reported outcomes (AF-related quality of life, symptom severity, and emotional and functional status). METHODS: The PaTH AF cohort study recruited participants (N = 953) with an AF diagnosis and age ≥ 18 years across 4 academic medical centers. We performed longitudinal multiple regression with random effects to determine if individual characteristics were associated with patient-reported outcomes. RESULTS: Women reported poorer functional status (β - 2.23, 95% CI: -3.52, - 0.94) and AF-related quality of life (β - 4.12, 95% CI: -8.10, - 0.14), and higher symptoms of anxiety (β 2.08, 95% CI: 0.76, 3.40), depression (β 1.44, 95% CI: 0.25, 2.63), and AF (β 0.29, 95% CI: 0.08, 0.50). Individuals < 60 years were significantly (p < 0.05) more likely to report higher symptoms of depression, anxiety, and AF, and poorer AF-related quality of life. Lack of college education was associated with reporting higher symptoms of AF (β 0.42, 95% CI: 0.17, 0.68), anxiety (β 1.86, 95% CI: 0.26, 3.45), and depression (β 1.11, 95% CI: 0.15, 2.38), and lower AF-related quality of life (β - 4.41, 95% CI: -8.25, - 0.57) and functional status. CONCLUSION: Women, younger adults, and individuals with lower levels of education reported comparatively poor patient-reported outcomes. These findings highlight the importance of understanding why individuals experience AF differently based on certain characteristics.

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