Quality of Life, Exercise Capacity and Comorbidity in Old Patients with Permanent Atrial Fibrillation

Background: The impact of atrial fibrillation (AF) on quality of life (QoL) differs with the AF population studied and is influenced by comorbidity. In hospital-based studies younger and highly symptomatic patients may be overrepresented. We performed an observational cross sectional study in two municipalities, comparing 75 year-old patients with and without permanent atrial fibrillation, with respect to health-related QoL and exercise capacity, with adjustment for the effects of confounders. Methods: Maximal treadmill exercise testing provided peak oxygen uptake (VO2 peak). Health-related QoL was assessed by self-completed SF-36 questionnaires. The lowest quartile identified poor outcomes.

27 subjects with permanent AF and 71 subjects in sinus rhythm participated. AF patients had higher prevalence of compensated chronic heart failure (p < 0.001), valvular heart disease (p < 0.001), lower mean VO2 peak (22.7 ± 5.5 vs. 28.6 ± 6.3 ml/kg/min; p < 0.001), and more often poor VO2 peak; crude OR 5.3 (95%CI 1.8, 15.3), adjusted OR 7.5 (2.0, 28.3). Median Physical Component Summary score (with 25th and 75th percentile) was 41 (31, 51) in AF vs. 52 (45, 55) in controls (p < 0.001). Furthermore, the AF group had higher odds for poor physical QoL scores; crude OR 5.0 (1.8, 13.7), adjusted OR 4.3 (1.5, 12.4). Median Mental Component Summary score was 56 (42, 61) in the AF group vs. 57 (51, 60) in controls (p=0.565). The AF group had non-significantly increased odds for poor mental QoL scores; crude OR 2.3 (0.8, 6.2), adjusted OR 2.8 (1.0, 8.4). Conclusion: Also after adjustment for confounders, older patients with permanent AF had higher odds for poor exercise capacity and poor physical QoL compared to subjects in sinus rhythm.