Serial Assessment of Patient-Reported Health Status and Subsequent Clinical Outcomes in Atrial Fibrillation

The Atrial Fibrillation Effect on Quality-of-Life (AFEQT) questionnaire is endorsed for symptom and quality-of-life assessment in atrial fibrillation (AF) but is typically measured once. Because patient-reported health status changes with treatment, serial AFEQT assessments may better reflect disease burden over time. We evaluated whether repeated AFEQT measurements are associated with subsequent outcomes and whether the most recent score is informative.

We analyzed a multicenter, prospective registry of stable outpatients with AF referred to 11 hospitals in Japan (2012-2018). Associations of baseline ("prior"), 12-month ("current"), and change in AFEQT overall summary (os) scores with all-cause death and heart failure (HF) hospitalization were examined using multivariable Cox models. Among 2,743 patients (mean [±SD] age 67.8±11.1 years; 31.9% women), 146 (5.3%) experienced HF hospitalization and 134 (4.9%) died over a median follow-up of 4.0 years. Higher current AFEQT-os and change scores, but not prior AFEQT-os, were associated with a lower risk of death/HF hospitalization, with adjusted hazard ratios (95% confidence intervals) per 5-point increase of 0.94 (0.91-0.97) and 0.96 (0.92-0.99), respectively. When modeled together, only current AFEQT-os remained independently associated with outcomes. In time-varying analyses, time-updated AFEQT-os predicted both death/HF hospitalization and all-cause death.

The most recent AFEQT-os is associated with mortality and HF hospitalization, whereas baseline scores provide limited prognostic value. Updating patient-reported health status may help with risk assessment in AF.