41Evolution of PROMS data and what it tells us about patients undergoing catheter ablation for atrial fibrillation

Abstract

Introduction: The main aim of performing catheter ablation (CA) in atrial fibrillation (AF) is to improve AF-related symptoms and enhance the quality of life. In this study, we investigated the association of body mass index (BMI) and other predictors with the patient reported quality of life outcome data. Methods: We recorded the data on AFEQT score (six variables) and EQ5D condition (five variables) from 144 patients who were undergoing first time radiofrequency CA. We recorded the data before the CA (baseline) and at 3, 6 and 12 months follow-up. All AFEQT variables were squared to account for the left skewness in the data and each variable was analysed by a separate single and multi-variable linear mixed model (LMM). Each of the EQ5D variables was categorised into a binary variable representing no adverse condition (normal) and any degree of adverse condition, and analysed by a generalised linear mixed model (GLMM). Results: The data of 144 patients (55 female and 89 male) represent 92 paroxysmal AF and 52 persistent AF cases. Based on single variable models, increased BMI values were negatively associated with daily activity score (p=0.023) and health score (p=0.025) while positively associated with pain (p=0.038); however, the BMI was not statistically significant in corresponding multi-variable models. The multi-variable GLMM of usual activities suggested that each unit increase in the BMI value on average increased the risk of reduced activty by 17% (p=0.006). The baseline AFEQT score was positively associated with the corresponding AFEQT score at subsequent time points (p<0.001). Persistent AF patients had an increased likelihood to express anxiety compared with the paroxysmal group (p=0.010). The effect of gender was also significant with males showing higher scores for symptoms (p=0.038), daily activities (p=0.029), treatment satisfaction (p=0.037) and overall score (p=0.029) compared to females. Conclusions: These PROMS data offer valuable insights into patients and the effect of CA on their AFrelated symptoms. Activity in patients with higher BMI could be a marker of their obesity rather than their AF. A strong association of baseline scores with subsequent time points suggested that patients with low baseline scores on average would record lower scores following ablation, thus patients' perception of their health has a role to play affecting PROMS data. Therefore targeting patients' pre-ablation scores for anxiety, weight loss, activity, particularly those for female patients, could affect outcomes and improve PROMS scores.