Generalized anxiety is a predictor of impaired quality of life in patients with atrial fibrillation: Findings from the prospective observational ARENA study.

Atrial fibrillation (AF) is associated with impaired health-related quality of life (HRQoL), an increased risk of morbidity, and mortality. Traditional AF-related outcomes (e.g., AF recurrence) primarily demonstrate the physiological benefits of AF management but do not focus on the benefits experienced subjectively by the patient (i.e., patient-reported outcomes), which have been suggested as optimal endpoints in AF intervention studies. The aim of this study is to identify medical and psychological factors associated with impaired HRQoL at 1-year follow-up. Using data from the prospective observational multicenter ARENA study in patients with AF, we analyzed associations between medical factors, anxiety, and HRQoL at 1-year follow-up assessed using 5-level EuroQoL-5D. In 1353 AF patients (mean age 71.4 ± 10.3 years, 33.8% female), none of the medical predictors (e.g., heart disease) or history of cardioversion were associated with HRQoL at the 1-year follow-up. Higher generalized anxiety (β = -0.114, p < .001) but not cardiac anxiety (β = -0.006, p = .809) at baseline predicted decreased HRQoL, independent of confounding variables and patients' medical status. Furthermore, the worsening of patients' generalized anxiety was associated with decreased HRQoL (ß = -0.091, p < .001). In contrast, the improvement of generalized anxiety over time predicted higher HRQoL (ß = 0.097, p < .001). Finally, the worsening of patients' cardiac anxiety over time was associated with decreased HRQoL (ß = -0.081, p < .001). Our results highlight the importance of anxiety as a predictor of future HRQoL in patients with AF. Additional studies to examine the impact of anxiety treatment on HRQoL in this population are needed. The investigators registered on ClinicalTrials.gov (NCT02978248) on November 30, 2016 https://clinicaltrials.gov/ct2/show/NCT02978248.

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Déclaration de conflit d'intérêts

Declaration of Competing Interest All authors have completed the Unified Competing Interest form at http://www.icmje.org/coi_disclosure.pdf and declare that (1) J.S. has received honoraria fees for research presentations of ARENA Registry; (2) C.C. has received salary support from BioXcel Pharmaceuticals and honoraria for talks to Sunovion Pharmaceuticals on topics unrelated to this research; (3) J.H. and C.C. have received stipends from Elsevier for editorial work for General Hospital Psychiatry; (4) D.T. reports receiving lecture fees/honoraria from AstraZeneca, Bayer Vital, Boehringer Ingelheim Pharma, Bristol-Myers Squibb, Daiichi Sankyo, Medtronic, Pfizer Pharma, Sanofi-Aventis, St. Jude Medical and ZOLL CMS; (5) CJ.S. has received lecture and authoring honoraria by b4c-Solutions, Elsevier publishers, Boehringer-Ingelheim and reports a grant by the Innovationsfonds of the Gemeinsamen Bundesausschusses (G-BA); (6) C·H-L. reports that he is receiving royalties from Hogrefe Huber Publishers for the German version of the Hospital Anxiety and Depression Scale. During the last three years, he has received lecture honoraria from Pfizer and Novartis and research support from the German Ministry of Education and Research (BMBF), the European Union, and the German Research Fund (DFG). Remaining authors have no competing interest to report.