Improving quality-of-life in patients with atrial fibrillation

Health-related quality-of-life (HRQOL) is impaired in some patients with atrial fibrillation (AF), particularly in the domains of physical functioning and physical role functioning. Increased frequency and severity of symptoms, reduced functional status, psychological distress, older age, and being female contribute to reduced HRQOL in these patients.

“To improve HRQOL for patients with AF, clinicians should aim to reduce symptoms, improve functional status, and optimize psychological well-being,” said Pamela J. McCabe, PhD, a clinical nurse researcher at the Mayo Clinic in Rochester, Minnesota, in her presentation entitled “Optimizing Quality of Life for Patients with Atrial Fibrillation” delivered at the American Heart Association (AHA) meeting.

McCabe focused on the different treatment approaches to manage and optimize quality of life for patients with AF.  Among these are pharmaceutical and nonpharmaceutical approaches to reduce AF symptoms by either controlling the heart rate or maintaining sinus function.

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“There is continued debate regarding the best approach to manage symptoms because outcomes of treatment are influenced by the type of AF (paroxysmal versus persistent) and the patient’s comorbid conditions,” she said.

More evidence to date supports the use of ablation therapy to improve HRQOL in patients with paroxysmal AF versus those with persistent AF, but McCabe pointed to a study by Bulkova et al (Circulation 2014) that showed the benefit of ablation therapy to improve HRQOL in patients with either type of AF.

A further way to manage symptoms of AF is to reduce the risks associated with disease progression, such as obesity, hypertension, and obstructive sleep apnea.  She said that emerging evidence suggests that moderate exercise training and approaches that address lifestyle management that reduce these risks also reduce symptoms and improve functional status in these patients.

Finally, McCabe said that little research has been done to evaluate interventions to improve or maintain psychological well-being in patients with AF, despite the lower HRQOL in some patients due to psychological distress.

“Interventions such as cognitive behavioral therapy and support groups implemented to improve psychological well-being in patients with other cardiovascular conditions should be evaluated in patients with AF,” she said.