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Original research
Associations of symptoms and quality of life with outcomes in patients with atrial fibrillation
  1. Philipp Krisai1,
  2. Steffen Blum1,
  3. Stefanie Aeschbacher1,
  4. Jürg H Beer2,
  5. Giorgio Moschovitis3,
  6. Fabienne Witassek4,
  7. Richard Kobza5,
  8. Nicolas Rodondi6,
  9. Elisavet Moutzouri6,
  10. Aamina Mahmood1,
  11. Jeff S Healey7,
  12. Christine S Zuern1,
  13. Michael Kühne1,
  14. Stefan Osswald1,
  15. David Conen7
  16. on behalf of the Swiss-AF study investigators
  1. 1 Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital, Basel, Basel Stadt, Switzerland
  2. 2 Department of Internal Medicine, Cantonal Hospital Baden, Baden, Aargau, Switzerland
  3. 3 Division of Cardiology, Ospedale Regionale di Lugano-Civico e Italiano, Lugano, Switzerland
  4. 4 Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
  5. 5 Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
  6. 6 Department of General Internal Medicine and Institute of Primary Health Care (BIHAM), Inselspital Bern, University of Bern, Bern, Switzerland
  7. 7 Population Health Research Institute and Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
  1. Correspondence to Professor David Conen, Population Health Research Institute, Hamilton, Ontario L8L 2X2, Canada; conend{at}


Objective We aimed to investigate changes in atrial fibrillation (AF)-related symptoms and quality of life (QoL) over time, and their impact on prognosis.

Methods We prospectively followed 3836 patients with known AF for a mean of 3.7 years. Information on AF-related symptoms and QoL was obtained yearly. The primary end point was a composite of stroke or systemic embolism. Main secondary end points included stroke subtypes, all-cause mortality, cardiovascular death, hospitalisation for congestive heart failure (CHF), myocardial infarction and major bleeding. We assessed associations using multivariable, time-updated Cox proportional hazards models.

Results Mean age was 72 years, 72% were male. Patients with AF-related symptoms (66%) were younger (70 vs 74 years, p<0.0001), more often had paroxysmal AF (56% vs 37%, p<0.0001) and had lower QoL (71 vs 72 points, p=0.009). The incidence of the primary end point was 1.05 and 1.02 per 100 person-years in patients with and without symptoms, respectively. The multivariable adjusted HR (aHR) (95% CIs) for the primary end point was 1.11 (0.77 to 1.59; p=0.56) for AF-related symptoms. AF-related symptoms were not associated with any of the secondary end points. QoL was not significantly related to the primary end point (aHR per 5-point increase 0.98 (0.94 to 1.03; p=0.37)), but was significantly related to CHF hospitalisations (0.92 (0.90 to 0.94; p<0.0001)), cardiovascular death (0.90 (0.86 to 0.95; p<0.0001)) and all-cause mortality (0.88 (0.86 to 0.90; p<0.0001)).

Conclusions AF-related symptoms were not associated with adverse outcomes and should therefore not be the basis for prognostic treatment decisions. QoL was strongly associated with CHF, cardiovascular death and all-cause mortality.

  • atrial fibrillation
  • stroke
  • epidemiology

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  • Collaborators Philipp Krisai, Steffen Blum, Stefanie Aeschbacher, Jürg H. Beer, Giorgio Moschovitis, Fabienne Witassek, Richard Kobza, Nicolas Rodondi, Elisavet Moutzouri, Aamina Mahmood, Jeff S. Healey, Christine S. Zuern, Michael Kühne, Stefan Osswald, David Conen

  • Contributors Conception and design: PK, SB, SA, MK, SO, DC. Analysis and interpretation of the data: PK, SB, SA, MK, DC. Drafting of the manuscript: PK, DC. Critical revision for important intellectual content: all authors. Final approval of the manuscript: all authors. Responsible for the overall content as the guarantors: PK, DC.

  • Funding The Swiss-AF cohort study is supported by grants of the Swiss National Science Foundation (Grant numbers 33CS30_1148474, 33CS30_177520 and 32 473B_176178), the Swiss Heart Foundation, the Foundation for Cardiovascular Research Basel (FCVR) and the University of Basel. DC is supported by the Hamilton Health Sciences RFA Strategic Initiative Programme. PK is supported by the University of Basel, the Mach-Gaensslen foundation and the Bangerter-Rhyner foundation.

  • Competing interests DC holds a McMaster University Department of Medicine Mid-Career Research Award. MK received grants from the Swiss National Science Foundation and the Swiss Heart Foundation, and lecture/consulting fees from Daiichi-Sankyo, Boehringer Ingelheim, Bayer, Pfizer-BMS, AstraZeneca, Sanofi-Aventis, Novartis, MSD, Medtronic, Boston Scientific, St. Jude Medical, Biotronik, Sorin, Zoll and Biosense Webster. JSH reports research grants and speaking fees from BMS/Pfizer and Servier.

  • Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Ethics approval The study protocols of both Basel Atrial Fibrillation and Swiss Atrial Fibrillation were approved by the local ethics committees.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request from the corresponding author.