44Sociodemographic and cardiovascular status but not anticoagulant choice independently predicts quality of life in patients with atrial fibrillation: results from the prefer in AF registry.

BACKGROUND: Atrial fibrillation (AF) confers significant morbidity through its symptoms, complications, and associated therapies. Only small studies have evaluated clinical determinants of quality of life (QoL) in AF. We evaluated these in a large cross-sectional study of AF patients, and compared QoL measures between patients on vitamin K antagonists (VKAs) versus the novel oral anticoagulants (NOACs: dabigatran, rivaroxaban and apixaban).

METHODS: The PREFER in AF registry (Prevention of Thromboembolic Events - European Registry in Atrial Fibrillation) enrolled 7243 consecutive AF patients aged above 18 years across centres in 7 European countries. Sociodemographic data, co-morbidities, AF characteristics, and therapies were evaluated for independent predictors of EQ5D index value, an overall measure of QoL derived from the EQ5D-5L health questionnaire, using univariate and multivariate logistic regression. Paired comparisons of EQ5D index value, visual analogue scale, and component measures were made between patients taking VKAs versus NOACs who were matched for age, gender, maximum EHRA score, CHA2DS2-VASc score, and HAS-BLED score, using propensity scoring (227 per group).

RESULTS: Reduced EQ5D index value (≤0.77) was independently associated with: age >65 years (OR: 1.57), female gender (OR: 1.75), unskilled occupation (OR: 1.97), heart failure (OR: 1.75), prior myocardial infarction (OR: 1.64), prior stroke (OR: 1.62), atrial tachyarrhythmia at assessment (OR: 1.26), and amiodarone therapy (OR:1.28) (p<0.01 all cases). No differences in EQ5D index value and the visual analogue scale were found between matched VKA and NOAC users.

CONCLUSIONS: Sociodemographic and cardiovascular status, as well antiarrhythmic but not anticoagulant choice, appear to influence QoL in patients with AF.