Hypertension and Diabetes as Determinants of Patient-Reported Quality of Life in Permanent Atrial Fibrillation

Background: In patients with permanent atrial fibrillation, hypertension and diabetes frequently coexist and contribute to adverse cardiovascular outcomes. Beyond traditional clinical outcomes, health-related quality of life has become an essential measure of disease burden. The Kansas City Cardiomyopathy Questionnaire (KCCQ) is a validated patient-reported outcome instrument widely used in cardiovascular populations, but its role in hypertensive diabetics has not been systematically explored. This study aimed to evaluate the impact of diabetes on patient-reported quality of life in hypertensive individuals with permanent atrial fibrillation and identify clinical determinants of impaired health status. Methods: We conducted a retrospective study on hypertensive patients with permanent atrial fibrillation hospitalized between January 2021 and December 2023 at the County Emergency Clinical Hospital of Timișoara. Patients completed the KCCQ during admission and were stratified into hypertension without diabetes (HTN-only, n = 89) and hypertension with type 2 diabetes (HTN + DM, n = 109). Demographic, laboratory, and echocardiographic data were analyzed. The primary outcome was the difference in KCCQ scores between groups. Multivariable regression identified independent predictors of quality of life, and logistic regression with ROC analysis evaluated predictors of low KCCQ (<50). Results: Among 198 patients (109 with diabetes, 89 without), mean KCCQ was lower in HTN + DM versus HTN-only patients (50.9 ± 11.3 vs. 54.9 ± 14.4, p = 0.034). Diabetic patients had worse renal function, higher uric acid, and greater inflammatory burden. KCCQ correlated positively with eGFR (r = 0.43, p < 0.001) and negatively with creatinine, urea, neutrophil percentage, left atrial volume, and age. In multivariable analysis, diabetes was not an independent predictor, whereas reduced eGFR, higher neutrophils, larger atrial volume, and HFrEF were significant determinants. Logistic regression for low KCCQ showed good discrimination (AUC 0.78, 95% CI: 0.72-0.84). Conclusions: Diabetes worsens health-related quality of life in hypertensive patients with permanent atrial fibrillation primarily through renal dysfunction, inflammation, and cardiac remodeling. Targeting these pathways may improve both outcomes and patient-perceived health.