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Published on: February 26, 2013
Effects of population-based screening for atrial fibrillation on quality of life
Emilie Katrine Kongebro1, Christian Kronborg2, Lucas Yixi Xing1
1Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Inge Lehmanns Vej 7, 2100, Copenhagen, Denmark.
Insights
Screening for atrial fibrillation in high-risk individuals did not improve quality of life over three years. Continuous screening did not show significant differences in health outcomes compared to usual care.
Area of Science:
- Cardiology
- Public Health
- Health Economics
Background:
- Screening for atrial fibrillation (AF) is increasingly common.
- The impact of AF screening on patient quality of life (QoL) is not fully understood.
- High-risk individuals may experience varied QoL outcomes following AF screening.
Purpose of the Study:
- To evaluate the effect of continuous atrial fibrillation screening on quality of life in high-risk individuals.
- To compare QoL outcomes between patients randomized to usual care versus those receiving screening with an implantable loop recorder.
- To assess changes in EQ-5D-5L index scores and EQ VAS over a three-year period.
Main Methods:
- A randomized controlled trial involving 6,004 participants with stroke risk factors.
- Participants were assigned to either usual care (n=4,503) or implantable loop recorder screening (n=1,501).
- Quality of life was measured using the EQ-5D-5L instrument, analyzing index scores and visual analogue scale (EQ VAS) at baseline and three years.
Main Results:
- After three years, 95% of participants were alive, and 86% had complete QoL data.
- Both groups experienced a decrease in EQ-5D-5L index scores and EQ VAS, with no statistically significant difference between the screening and control groups (p=0.063 and p=0.056).
- Major problems, particularly pain/discomfort, were reported, with no significant difference in the occurrence of any major problem between groups.
Conclusions:
- Population-based, continuous screening for atrial fibrillation in high-risk individuals did not lead to improved quality of life.
- The study found no significant difference in QoL outcomes between AF screening and usual care.
- Long-term continuous screening for AF in high-risk populations may not enhance patient-reported quality of life.
Background:
Screening for atrial fibrillation is rising and may worsen or improve quality of life.
Methods:
We assessed quality of life (EQ-5D-5L) data in 6,004 participants with stroke risk factors randomised to usual care (n=4,503) or implantable loop recorder with anticoagulation upon detection of atrial fibrillation (n=1,501). Five domains (mobility, selfcare, usual activities, pain/discomfort, anxiety/depression) each scored from one to five were calculated into individual index scores (worst=-0.76, best=1.00). Changes in the index score and the visual analogue scale score (EQ VAS (0=worst, 100=best)) from baseline to year three were the primary outcomes, which were analysed using linear mixed models. Major problem was defined as a domain score ≥3 and analysed with logistic regression in year three.
Results:
Of 6,004 participants, 5,733 (95 %) were alive after three years, and 5,162 (86 %) had complete EQ-5D-5L data. The baseline index score of 5,733 participants was 0.88 ±0.16, which decreased by -0.05 (-0.05; -0.04) in the control vs -0.04 (-0.05; -0.03) in the screening group after three years, and a baseline EQ VAS score of 78.4±16.2, which decreased by -6.06 (-6.54; -5.57) in control vs -5.18 (-5.95; -4.40) in the screening group after three years, with no significant difference between the groups (p=0.063 and p=0.056, respectively). The most frequent problem was major pain/discomfort (1,202 of 5,162 (23.3 %)), and any major problem occurred equally in the groups after three years (OR 0.91 (0.79;1.05)).
Conclusion:
A population-based, long-term, and continuous screening for atrial fibrillation in high-risk individuals did not translate into increased quality of life.
