TY - JOUR
T1 - Symptom severity is associated with cardiovascular outcome in patients with permanent atrial fibrillation in the RACE II study
AU - Vermond, Rob A
AU - Crijns, Harry J G M
AU - Tijssen, Jan G P
AU - Alings, A Marco
AU - Van den Berg, Maarten P
AU - Hillege, Hans L
AU - Van Veldhuisen, Dirk J
AU - Van Gelder, Isabelle C
AU - Rienstra, Michiel
N1 - Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: [email protected].
PY - 2014/10
Y1 - 2014/10
N2 - AIMS: Symptoms and symptom burden have a central place in diagnosis and management of atrial fibrillation (AF). The aim of the present study is to investigate whether severity of AF symptoms impacts prognosis in permanent AF.METHODS AND RESULTS: We studied the relation between AF symptom severity [quantified with the Toronto AF Severity Scale (AFSS)] and cardiovascular outcome in patients included in the RACE II study. The primary endpoint was a composite of cardiovascular morbidity and mortality. Secondary outcome was cardiovascular hospitalizations. Of 614 permanent AF patients in RACE II, AFSS questionnaires were available in 558 patients (91%). Mean age was 68 ± 8 years. One hundred and seventy-four patients (31%) reported a low score (score 0-3; lowest tertile), 190 patients (34%) reported a moderate score (score 4-9; middle tertile), and 194 (35%) reported a high score (score 10-35; highest tertile). Patients with the most severe symptoms were more often women, had higher N-terminal prohormone of brain natriuretic peptide concentrations, and had more previous heart failure hospitalizations. Median follow-up was 3.0 (interquartile range 2.3-3.0) years. The primary endpoint occurred most frequently in the highest tertile of the AFSS [16 (9%), 19 (10%), 36 (19%), respectively, P = 0.01], being mainly driven by heart failure hospitalizations [4 (2%), 1 (1%), 16 (8%), respectively, P < 0.001]. After multivariable adjustment, higher AFSS scores were associated with the primary endpoint [hazard ratio 1.38 (1.15-1.66), P = 0.001], as well as with cardiovascular hospitalizations [hazard ratio 1.33 (1.14-1.54), P < 0.001].CONCLUSION: In permanent AF, after multivariable adjustment, symptom severity is associated with cardiovascular outcome.
AB - AIMS: Symptoms and symptom burden have a central place in diagnosis and management of atrial fibrillation (AF). The aim of the present study is to investigate whether severity of AF symptoms impacts prognosis in permanent AF.METHODS AND RESULTS: We studied the relation between AF symptom severity [quantified with the Toronto AF Severity Scale (AFSS)] and cardiovascular outcome in patients included in the RACE II study. The primary endpoint was a composite of cardiovascular morbidity and mortality. Secondary outcome was cardiovascular hospitalizations. Of 614 permanent AF patients in RACE II, AFSS questionnaires were available in 558 patients (91%). Mean age was 68 ± 8 years. One hundred and seventy-four patients (31%) reported a low score (score 0-3; lowest tertile), 190 patients (34%) reported a moderate score (score 4-9; middle tertile), and 194 (35%) reported a high score (score 10-35; highest tertile). Patients with the most severe symptoms were more often women, had higher N-terminal prohormone of brain natriuretic peptide concentrations, and had more previous heart failure hospitalizations. Median follow-up was 3.0 (interquartile range 2.3-3.0) years. The primary endpoint occurred most frequently in the highest tertile of the AFSS [16 (9%), 19 (10%), 36 (19%), respectively, P = 0.01], being mainly driven by heart failure hospitalizations [4 (2%), 1 (1%), 16 (8%), respectively, P < 0.001]. After multivariable adjustment, higher AFSS scores were associated with the primary endpoint [hazard ratio 1.38 (1.15-1.66), P = 0.001], as well as with cardiovascular hospitalizations [hazard ratio 1.33 (1.14-1.54), P < 0.001].CONCLUSION: In permanent AF, after multivariable adjustment, symptom severity is associated with cardiovascular outcome.
KW - Aged
KW - Atrial Fibrillation/mortality
KW - Biomarkers/analysis
KW - Cardiovascular Diseases/mortality
KW - Chronic Disease
KW - Electrocardiography, Ambulatory
KW - Endpoint Determination
KW - Female
KW - Heart Rate/drug effects
KW - Hospitalization/statistics & numerical data
KW - Humans
KW - Male
KW - Prognosis
KW - Risk Factors
KW - Severity of Illness Index
KW - Surveys and Questionnaires
U2 - 10.1093/europace/euu151
DO - 10.1093/europace/euu151
M3 - Article
C2 - 24938627
SN - 1099-5129
VL - 16
SP - 1417
EP - 1425
JO - Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology
JF - Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology
IS - 10
ER -