UMMS Affiliation

Division of Cardiovascular Medicine, Department of Medicine; Division of Geriatrics, Department of Medicine; Meyers Primary Care Institute

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Document Type



Cardiology | Cardiovascular Diseases | Clinical Epidemiology | Epidemiology | Geriatrics


Background: Among older patients with atrial fibrillation, there are limited data examining clinically meaningful changes in quality of life (QoL). We examined the extent of, and factors associated with, clinically meaningful change in QoL over 1-year among older adults with atrial fibrillation.

Methods and Results: Patients from cardiology, electrophysiology, and primary care clinics in Massachusetts and Georgia were enrolled in a cohort study (2015-2018). The Atrial Fibrillation Effect on Quality-of-Life questionnaire was used to assess overall QoL and across 3 subscales: symptoms, daily activities, and treatment concern. Clinically meaningful change in QoL (ie, difference between 1-year and baseline QoL score) was categorized as either a decline ( < /=-5.0 points), no clinically meaningful change (-5.0 to +5.0 points), or an increase ( > /=+5.0 points). Ordinal logistic models were used to examine factors associated with QoL changes. Participants (n=1097) were on average 75 years old, 48% were women, and 87% White. Approximately 40% experienced a clinically meaningful increase in QoL and 1 in every 5 patients experienced a decline in QoL. After multivariable adjustment, women, non-Whites, those who reported depressive and anxiety symptoms, fair/poor self-rated health, low social support, heart failure, or diabetes mellitus experienced clinically meaningful declines in QoL.

Conclusions: These findings provide insights to the magnitude of, and factors associated with, clinically meaningful change in QoL among older patients with atrial fibrillation. Assessment of comorbidities and psychosocial factors may help identify patients at high risk for declining QoL and those who require additional surveillance to maximize important clinical and patient-centered outcomes.


atrial fibrillation, elderly, quality of life

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© 2020 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

DOI of Published Version



Abu HO, Saczynski JS, Mehawej J, Tisminetzky M, Kiefe CI, Goldberg RJ, McManus DD. Clinically Meaningful Change in Quality of Life and Associated Factors Among Older Patients With Atrial Fibrillation. J Am Heart Assoc. 2020 Sep 15;9(18):e016651. doi: 10.1161/JAHA.120.016651. Epub 2020 Sep 2. PMID: 32875941. Link to article on publisher's site

Journal/Book/Conference Title

Journal of the American Heart Association

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Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.