Procena povezanosti kvaliteta života obolelih od atrijalne fibrilacije i kardiovaskularnih ishoda tokom jednogodišnjeg praćenja
Sažetak
Аутор: Ана Влајковић, Матеј Вилотијевић
e-mail: anavlajkovic1@gmail.com
Ментор: кл.асист. др Марија Половина
Клиника за кардиологију, Клинички центар Србије, Медицински факултет Универзитета у Београду
Увод: Истраживања показују да атријална фибрилација (АФ) може негативно да утиче на квалитет живота (QoL) и да карактеристике симптоматске презенетације АФ, као и њен утицај на QoL могу бити повезани са неповољним кардиоваскуларним исходима.
Циљеви рада: су да применом Atrial Fibrilation Effect on Quality-of-life (AFEQT) упитника процени QoL болесника са АФ и да се испита повезаност QoL са кардиоваскуларним исодима током једногодишњег клиничког праћења.
Материјал и методе: Опсервациона, кохортна студија у коју су укључени болесници лечени у Клиници за кардиологију Клиничког центра Србије који су прихватили да попуне AFEQT упитник за процену укупног QoL (AFEQT скор, од 0 до 100) и 4 аспекта QoL – симптоми, ограничења у дневним активностима, забринутост због последица лечења и задовољство лечењем. Током проспективног једногодишњег праћења евидентирани су исходи студије: 1) значајни кардиоваскуларни догађај – комбиновани исход који укључује мождани удар/транзиторни исхемијски атак, инфаркт миокарда, перкутану/хируршку коронарну реваскуларизацију или кардиоваскуларну смрт, 2) хоспитализација због срчане инсуфицијенције.
Резултати: Укључено је 202 болесника (средња старост: 64,5±12,4 година; 62,9% мушкарци; 24,3% асимптоматска АФ). Средња вредност AFEQT скора је 64,3± 8,8. Показана је негативна корелација између објективне процене тежине симптома и AFEQT скора (Spearman rho = -0,489, p<0,001). Током једногодишењег праћења значајан кардиоваскуларни догађај је забележен код 8,4% испитаника, а хоспитализација због срчане инсуфицијенције је регистрована код 3,5%. У мултиваријантном регресионом моделу контролисаном за клиничке варијабле, скор којим је процењено задовољство терапијом био је повезан са значајним кардиоваскуларним догађајем (ОR, 0,97; 95%CI, 0,94-0,99; P=0,022), док је укупни AFEQT скор био повезан са хоспитализацијом због срчане инсуфицијенције (ОR, 0,98; 95%CI, 0,95-0,99; P=0,014).
Закључак: резултати истраживања показују да се АФ неповољно одражава на QoL. Бољи QoL процењен АFEQT скором и веће задовољство пацијената спроведеним лечењем су повезани са мањом вероватноћом неповољних исхода, што је од значаја у клиничкој процени ризика и спровођењу одговарајућих терапијских мера код болесника са АФ.
Кључне речи: атријална фибрилација, квалитет живота, упитник, процена исхода лечења
ASSESMENT OF ASSOCIATION BETWEEN QUALITY OF LIFE IN PATIENTS WITH ATRIAL FIBRILLATION AND CARDIOVASCULAR OUTCOMES DURING THE ONE-YEAR FOLLOW-UP
Author: Ana Vlajković, Matej Vilotijević
e-mail: anavlajkovic1@gmail.com
Mentor: TA, Marija Polovina
Cardiology Clinic, Clinical Center of Serbia, Medical School, University of Belgrade, Serbia
Introduction: Research evidence indicates that atrial fibrillation (AF) could have a negative impact on the quality-of-life (QoL). AF symptom pattern and AF-related QoL have been associated with adverse cardiovascular outcomes.
The aims: the aims of the present study are to evaluate AF-related impact on QoL using the Atrial Fibrillation Effect on Quality-of-Life (AFEQT) questionnaire, and to assess the association of QoL with adverse cardiovascular outcomes during the 1-year follow-up.
Materials and Methods: An observational, cohort study that included AF patients treated at the Cardiology Clinic, Clinical Center of Serbia, willing to fill-in AFEQT questionnaire to assess the overall QoL (AFEQT score, 0 to 100) and QoL components: symptoms, daily activities, treatment concerns and treatment satisfaction. During the prospective 1-year follow-up, data on the following outcomes were collected: 1) major adverse cardiovascular outcomes - a combined endpoint, including: stroke/transient ischemic attack, myocardial infarction, percutaneous/surgical coronary revascularization, or cardiovascular death; 2) hospitalization for heart failure.
Results: We included 202 AF patients (mean age: 64.5±12.4 years; 62.9% men; 24.3% asymptomatic AF). The mean AFEQT score was 64.3± 8.8. There was a negative correlation between objective estimate of AF-related symptoms and AFEQT score (Spearman rho = -0.489, P<0.001). During 1-year follow-up, major adverse cardiovascular outcomes occurred in 8.4% of patients and 3.5% were hospitalized for heart failure. In a multivariate logistic regression model, controlling for clinical variables, treatment satisfaction score was significantly associated with major adverse cardiovascular outcomes (OR, 0.97; 95%CI, 0.94-0.99, P=0.022), while the overall AFEQT score was associated with heart failure hospitalizations (OR, 0.98; 95%CI, 0.95-0.99; P=0.014).
Conclusion: our results indicate that AF has a negative impact on QoL. Better QoL as assessed by AFEQT score and higher treatment satisfaction are associated with reduced odds for adverse outcomes, which is relevant for clinical risk-stratification and appropriate treatment of AF patients.
Keywords: atrial fibrillation, quality of life, questionnaire, assessment of treatment outcomes
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