Objectives: To determine the association of AF therapies with patient-reported outcomes.
Methods: The PaTH AF Longitudinal Cohort Study recruited participants (N=953) with an AF diagnosis and age ≥18 years across 4 academic medical centers.(5) Propensity-score matching was used to address potential confounding of the association between AF therapies (rate control medication and rhythm control medication) and patient-reported outcomes (quality of life, symptom severity, and emotional and functional status). Matching 1:10 was conducted separately for rate control medication and rhythm control medicaiton. Analyses were restricted to individuals who could be matched to another participant with a similar probability (caliper < 0.04) of receiving the therapy. This approach reduces the possibility of model extrapolations and the biasing effects of model misspecification.(6–8) We performed multiple linear regressions on propensity-matched cohorts to determine the association of AF therapies on patient-reported outcomes reported. AF therapies (rate and rhythm control medications) and individual characteristics (age, sex, and education level) and site were independent variables. AF-related quality of life, symptom severity, emotional and functional status were dependent variables. Illness characteristics (comorbidities and body mass index) were included as covariates.
Results: The sample (n=953) was 35% female with a mean age of 72±10. In the propensity-score matched subsamples, AF therapies were not associated with more favorable patient-reported outcomes. Prescription of rate control medication was associated with poorer functional status (β -3.68, 95% CI: -5.29, -2.07) and higher symptoms of depression (β 1.78, 95% CI: 0.24, 3.31). Prescription of rhythm control medication was associated with comparatively poorer AF-related quality of life (β -5.71, 95% CI: -10.38, -1.04).
Conclusions: In propensity-score matched samples controlling for BMI and comorbidities, prescriptions of rate and rhythm control medication were associated with less favorable patient-reported outcomes following the therapy. The adverse effects of AF therapies may outweigh the positive effects of sinus rhythm and rate control.