Quality of Life and Frailty Syndrome in Patients with Atrial Fibrillation

Figures & data

Table 1 General Social Characteristics of the Patients Studied

Characteristics (Variable)	Total N=158
Age (Years)
M±SD	70.4±7.6
Me [Q1; Q3]	69 [64; 76]
Education	n	%
Primary	11	7.0
Vocational	75	47.5
High school	40	25.3
College/university	32	20.3
Residence
Rural	66	41.8
Urban	92	58.2
Source of Income
Professional activity	54	34.2
Disability pension	5	3.2
Retirement pension	99	62.7
Type of Work (Current or Past)
Blue-collar	80	50.6
White-collar	48	30.4
Other	30	19.0
Marital Status
Single	82	51.9
In a relationship	76	48.1
Physical Activity
No	74	46.8
Yes	84	53.2

Q1, quartile 1; Q3, quartile 3; N, total number of patients; n, number of patients.

Abbreviations: M, mean; SD, standard deviation; Me, median; Q1, quartile 1; Q3, quartile 3; N, total number of patients; n, number of patients.

Table 2 Clinical Characteristics of the Study Group

Characteristics (Variable)	Total N=158
	n	%
Cigarette Smoking
Yes	65	41.1
No	57	36.1
Not anymore	36	22.8
Regular Alcohol Consumption
Yes	18	11.4
No	98	62.0
Not anymore	42	26.6
Duration of AF (Years)
M±SD	6.9±4.7
Comorbidities
Arterial hypertension	126	79.7
Ischemic heart disease	81	51.3
Diabetes mellitus	91	57.6
Heart failure	33	20.9
Hyperthyroidism*	30	19.0
Respiratory disorders	85	53.8
Stroke/TIA	42	26.6
Number of Hospitalizations Due to AF
1–2	40	25.3
3–5	48	30.4
6–10	27	17.1
More than 10	43	27.2
Anticoagulant Treatment
NOAC	91	57.6
VKA	67	42.4
EFS (Total Score):
M±SD	8.5±5.0
Frailty Level
No frailty (0–5 points)	58	36.7
Vulnerable to frailty (6–7 points)	16	10.1
Mild frailty (8–9 points)	41	25.9
Moderate frailty (10–11 points)	16	10.1
Severe frailty (12–17 points)	27	17.1

Note: *Present as well in the past medical history.

Abbreviations: EFS, Edmonton Frailty Scale; M, mean; SD, standard deviation; AF, atrial fibrillation; NOAC, new oral anticoagulants; VKA, vitamin K antagonist; TIA, transient ischemic attack; N, total number of patients; n, number of patients.

Table 3 Arrhythmia-Specific Symptoms and QoL by ASTA Part I in Patients Divided by Frailty Status

ASTA Part I	Frail N=84		Non-Frail N=74		Test Result (p)
	n	%	n	%
ASTA I. 1. When did you last experience arrhythmia?					<0.001
I have persistent arrhythmia	43	27.2	30	35.7
I have arrhythmia on and off every day	31	19.6	28	33.3
Less than a week ago	20	12.7	6	7.1
Less than a month ago	23	14.6	4	4.8
Between 1 and 3 months ago	17	10.8	6	7.1
Between 3 and 6 months ago	16	10.1	3	3.6
Between 6 and 12 months ago	5	3.2	4	4.8
More than 12 months ago	3	1.9	3	3.6
ASTA I. 2a. Are you currently on medication?					0.002
No	0	0.0	8	10.8
Yes	84	100.0	66	89.2
ASTA I. 2b. Which medications do you take regularly?
Βeta blockers	33	39.3	57	77.1	<0.001
Anti-arrhythmic drugs	18	21.4	3	4.1
Digoxin	13	15.5	6	8.1
Calcium channel blockers	20	23.9	4	5.5
VKA NOAC	48 37	57.1 42.9	34 40	45.95 54.05	<0.001

Notes: ASTA data from Walfridsson U, Arestedt K, Stromberg A. Development and validation of a new Arrhythmia-Specific questionnaire in Tachycardia and Arrhythmia (ASTA) with focus on symptom burden. Health Qual Life Outcomes. 2012;10:44. Copyright © 2012 Walfridsson et al; licensee BioMed Central Ltd. Creative Commons Attribution License available at: https://creativecommons.org/licenses/by/2.0/legalcode⁵⁰

Abbreviations: N, total number of patients; n, number of patients.

Table 4 Arrhythmia-Specific Symptoms Characteristic Between Frail and Non-Frail AF Patients

ASTA Part II – Arrhythmia-Specific Symptoms	Frail N=84		Non-Frail N=74		Test Result (p)
	n	%	n	%
ASTA II. 1. How many times have you experienced arrhythmia during the last 3 months?					<0.001
None	10	11.9	14	18.9
Fewer than 5	3	3.6	37	50.0
Between 5 and 15	12	14.3	9	12.2
Between 16 and 30	0	0.0	1	1.4
More than 30 (but not every day)	1	1.2	1	1.4
I experience arrhythmia on and off every day	28	33.3	3	4.1
I have persistent arrhythmia	30	35.7	9	12.2
ASTA II. 2. How long does your arrhythmia usually last?					<0.001
Less than 1 hour	9	10.7	0	0.0
Between 1 and 7 hours	11	13.1	25	33.8
Between 7 and 24 hours	22	26.2	21	28.4
Between 24 and 48 hours	13	15.5	18	24.3
Between 2 and 7 days	1	1.2	0	0.0
More than 7 days	28	33.3	10	13.5
ASTA II. 3. What is the longest time your arrhythmia has ever lasted?					<0.001
Between 24 and 48 hours	16	19.0	39	52.7
Between 2 and 7 days	31	36.9	25	33.8
More than 7 days	37	44.0	10	13.5
ASTA II. 4. Do you experience any of the following in connection with your arrhythmia?
My heart beats fast	32	38.1	50	67.6	<0.001
My heart beats regularly	0	0.0	0	0.0	1.000
My heart beats irregularly	44	52.4	52	70.3	0.033
My heart beats harder than usually	14	16.7	19	25.7	0.232
A feeling that my heart is missing one or more beats	23	27.4	30	40.5	0.114
Short episodes of arrhythmia lasting less than 1 minute	6	7.1	1	1.4	0.122
No, I do not experience any of the above	26	31.0	10	13.5	0.016
ASTA II. 5. Does your arrhythmia occur on specific occasions?					0.563
No	47	56.0	38	51.4
Yes	37	44.0	36	48.6
ASTA II. 7. Have you ever come close to fainting due to your arrhythmia?					0.071
No	29	34.5	37	50.0
Yes	55	65.5	37	50.0
ASTA II. 8. Have you ever fainted due to your arrhythmia?					<0.001
No	43	51.2	64	86.5
Yes	41	48.8	10	13.5
Symptom severity (total ASTA II score)					<0.001
M±SD	14.9±4.1		11.9±4.9
Me [Q1; Q3]	14 [12; 18]		11 [9; 14]

Notes: ASTA data from Walfridsson U, Arestedt K, Stromberg A. Development and validation of a new Arrhythmia-Specific questionnaire in Tachycardia and Arrhythmia (ASTA) with focus on symptom burden. Health Qual Life Outcomes. 2012;10:44. Copyright © 2012 Walfridsson et al; licensee BioMed Central Ltd. Creative Commons Attribution License available at: https://creativecommons.org/licenses/by/2.0/legalcode.⁵⁰

Abbreviations: M, mean; SD, standard deviation; Me, median; Q1, quartile 1; Q3, quartile 3; N, total number of patients; n, number of patients.

Table 5 QoL of the Patients Studied Between Fraily and Non-Frail AF Patients

ASTA Part III – HRQoL	Frail N=84		Non-Frail N=74		Test Result (p)
	n	%	n	%
ASTA III. 1. Do you feel unable to work, study, or carry out daily activities as you would like to do, due to your arrhythmia?					<0.001
Yes, a lot	30	35.7	4	5.4
Yes	41	48.8	22	29.7
Yes, to a certain extent	8	9.5	24	32.4
No	5	6.0	24	32.4
ASTA III. 2. Do you spend less time with your family/relatives and friends than you would like to spend, due to your arrhythmia?					<0.001
Yes, a lot	16	19.0	1	1.4
Yes	47	56.0	15	20.3
Yes, to a certain extent	12	14.3	22	29.7
No	9	10.7	36	48.6
ASTA III. 3. Do you spend less time with acquaintances (people you do not know that well) than you would like to spend, due to your arrhythmia?					<0.001
Yes, a lot	19	22.6	1	1.4
Yes	39	46.4	15	20.3
Yes, to a certain extent	20	23.8	27	36.5
No	6	7.1	31	41.9
ASTA III. 4. Do you avoid planning things you would like to do, for instance traveling or leisure activities, due to your arrhythmia?					<0.001
Yes, a lot	24	28.6	2	2.7
Yes	39	46.4	14	18.9
Yes, to a certain extent	18	21.4	30	40.5
No	3	3.6	28	37.8
ASTA III. 5. Is your physical ability impaired due to your arrhythmia?					<0.001
Yes, a lot	24	28.6	1	1.4
Yes	50	59.5	19	25.7
Yes, to a certain extent	10	11.9	44	59.5
No	0	0.0	10	13.5
ASTA III. 6. Is your ability to concentrate impaired due to your arrhythmia?					<0.001
Yes, a lot	25	29.8	1	1.4
Yes	47	56.0	24	32.4
Yes, to a certain extent	12	14.3	42	56.8
No	0	0.0	7	9.5
ASTA III. 7. Do you feel dejected or sad due to your arrhythmia?					<0.001
Yes, a lot	20	23.8	1	1.4
Yes	43	51.2	21	28.4
Yes, to a certain extent	20	23.8	46	62.2
No	1	1.2	6	8.1
ASTA III. 8. Do you feel irritated or angry due to your arrhythmia?					0.033
Yes, a lot	8	9.5	3	4.1
Yes	22	26.2	14	18.9
Yes, to a certain extent	33	39.3	46	62.2
No	21	25.0	11	14.9
ASTA III. 9. Do you experience trouble sleeping due to your arrhythmia?					<0.001
Yes, a lot	8	9.5	3	4.1
Yes	57	67.9	30	40.5
Yes, to a certain extent	19	22.6	36	48.6
No	0	0.0	5	6.8
ASTA III. 10. Is your sexual life negatively affected by your arrhythmia?					<0.001
Yes, a lot	12	14.3	0	0.0
Yes	32	38.1	19	25.7
Yes, to a certain extent	8	9.5	33	44.6
No	32	38.1	22	29.7
ASTA III. 11. Do you experience a fear of death due to your arrhythmia?					0.096
Yes, a lot	10	11.9	3	4.1
Yes	40	47.6	30	40.5
Yes, to a certain extent	21	25.0	30	40.5
No	13	15.5	11	14.9
ASTA III. 12. Has your life situation deteriorated due to your arrhythmia?					<0.001
Yes, a lot	3	3.6	0	0.0
Yes	43	51.2	11	14.9
Yes, to a certain extent	26	31.0	39	52.7
No	12	14.3	24	32.4
ASTA III. 13. Do you fear that your symptoms will occur again during the periods when you do not have arrhythmia?					0.009
Yes, a lot	13	15.5	14	18.9
Yes	59	70.2	36	48.6
Yes, to a certain extent	9	10.7	11	14.9
No	3	3.6	13	17.6
Impact of arrhythmia on QoL (total score)					<0.001
M±SD	23.5±5.2		14.5±5.5
Me [Q1; Q3]	24 [20; 26]		14 [11; 18]
Min–Max	13–39		2–29

Notes: ASTA data from Walfridsson U, Arestedt K, Stromberg A. Development and validation of a new Arrhythmia-Specific questionnaire in Tachycardia and Arrhythmia (ASTA) with focus on symptom burden. Health Qual Life Outcomes. 2012;10:44. Copyright © 2012 Walfridsson et al; licensee BioMed Central Ltd. Creative Commons Attribution License available at: https://creativecommons.org/licenses/by/2.0/legalcode.⁵⁰

Abbreviations: M, mean; SD, standard deviation; Me, median; Q1, quartile 1; Q3, quartile 3; N, total number of patients; n, number of patients; HRQoL, health-related quality of life.

Table 6 Correlation Coefficients for Symptom Severity (ASTA II) and QoL (ASTA III), and the Characteristics Analyzed in the Study Group

Characteristics (Variable)	All Patients
	ASTA II		ASTA III
	R	p	r	p
Age	0.254	0.010	0.424	<0.001
Education (primary)	−0.150	0.135	0.252	0.012
Residence (rural)	−0.168	0.093	0.101	0.310
Professionally active (yes)	−0.171	0.087	−0.450	<0.001
Living alone (no)	0.036	0.720	0.138	0.167
Physically active (yes)	−0.344	0.001	−0.528	<0.001
No symptoms	−0.244	0.015	0.188	0.237
Arterial hypertension	−0.033	0.738	−0.070	0.484
Ischemic heart disease	0.267	0.008	0.268	0.007
Diabetes mellitus	0.377	<0.001	0.434	<0.001
Heart failure	0.129	0.197	0.223	0.026
Hyperthyroidism	−0.113	0.258	0.169	0.091
Respiratory disorders	0.354	<0.001	0.436	<0.001
Stroke/TIA	0.170	0.089	0.414	<0.001
Number of hospitalizations	0.288	0.004	0.493	<0.001
Knowledge on AF symptoms	−0.093	0.353	−0.291	0.004
Knowledge on AF treatment	−0.093	0.353	−0.350	0.001
Frailty syndrome	0.454	<0.001	0.642	<0.001

Abbreviation: r/R, correlation coefficients; TIA, transient ischemic attack.

Table 7 Regression Coefficients for Symptom Severity (ASTA II) and Quality of Life (ASTA III) and the Characteristics Analyzed in the Study Group

Characteristics (Variable)	ASTA II				ASTA III
	Analysis Univariate		Analysis Multivariate		Analysis Univariate		Analysis Multivariate
	b	p	b	p	b	p	b	p
Age (years)	0.017	0.795	–	>0.05	−0.203	0.016	–	>0.05
Education (primary)	0.250	0.067	–	>0.05	0.451	0.074	–	>0.05
Physically active	−2.111	0.223	–	>0.05	−4.718	0.032	−6.454	0.002
Ischemic heart disease	0.246	0.834	–	>0.05	2.986	0.044	–	>0.05
Heart failure	1.782	0.521	–	>0.05	2.013	0.212	–	>0.05
Diabetes mellitus	1.921	0.048	–	>0.05	3.321	0.007	3.875	0.001
Number of hospitalizations	0.345	0.022	–	>0.05	2.541	0.023	–	0.05
Knowledge on AF symptoms	−2.116	0.017	–	>0.05	−0.231	0.842	–	>0.05
Knowledge on AF treatment	−3.512	0.047	–	>0.05	−0.623	0.041	–	>0.05
Frailty (degree)	1.443	<0.001	1.244	<0.001	1.723	0.004	1.012	0.001

Abbreviation: b, regression coefficient.

Walfridsson U, Arestedt K, Stromberg A, Development and validation of a new Arrhythmia-Specific questionnaire in Tachycardia and Arrhythmia (ASTA) with focus on symptom burden. Health Qual Life Outcomes. 2012;10:44.22545926

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