The primary goal of catheter ablation (CA) in patients with atrial fibrillation (AF) is to reduce symptom burden and improve health–related quality of life (HRQoL), such that long–term follow-up is not frequently required. To examine the long–term effect of CA and analyze predictors of symptom recurrence, Ulla Walfridsson and colleagues examined patient–reported outcome measures (PROMs) from a cohort of patients with AF. They observed that CA had positive long–term impacts on symptoms and HRQoL. Specifically, “half of the patients did not experience any symptoms and more than 80% of those still having symptoms experienced an improvement.”
Their report, published in Clinical Cardiology, also suggested that PROMs are feasible for use in clinical care. Additionally, the authors reported that female gender, the presence of ischemic heart disease (IHD), and obesity were factors that predicted remaining symptoms, “the latter serving as an important reminder to encourage lifestyle management.”
The study included 1,521 patients, of whom 69% were men and the mean age was 62 years, from the Linköping University Hospital in Sweden. Arrhythmia–related symptoms and HRQoL were measured with the Arrhythmia-Specific questionnaire in Tachycardia and Arrhythmia (ASTA).
At the end of the five-year study period, 50% of patients reported freedom from symptoms, among which 18% had a symptom reduction of more than 50%, 14% had a minor reduction, and 18% reported no effect or a worsening of symptoms. Factors that predicted symptom recurrence were female gender (hazard ratio [HR] = 1.8; 1.2–2.8), body mass index ≥ 35 (HR = 3.9; 1.6–9.8), and IHD (HR = 2.6; 1.2–5.9). After five years, breathlessness during activity, weakness or fatigue, and tiredness were still the most common disease symptoms. For HRQoL, the most common symptoms were impaired physical ability and “deteriorated life situation.”
The authors ultimately concluded that using “disease-specific PROMs for long-term follow-up in a routine clinical setting was feasible and added important clinical information about the care of patients with AF.”