Atrial Fibrillation Effect on QualiTy of life (AFEQT) 1 ST M A Y 2012

Transcription

1 Atrial Fibrillation Effect on QualiTy of life (AFEQT) RACHEAL JAMES A RRHYTHMIA NURSE SPECIALIST A F SERVICE DELIVERY MEETING & WORKSHOP WHAT IS BEST PRACTICE? 1 ST M A Y 2012

2 Atrial Fibrillation Atrial Fibrillation is caused by multiple micro reentry circuit within the atrial tissue ( per minute) which results in chaotic atrial activity. It is manifested on ECG by absent P waves, an irregular baseline, and irregularly irregular ventricular complexes.

3 Strategies for the management of AF Stroke prevention Risk stratify: CHAD2VAS 2 or CHADS2 scores Anticoagulants (novel Warfarin or new agents Dabigatran) Underutilized Rate control Adequate rate control defined as achievement of arbitrary heart rate target at rest and exercise Rhythm control Revert to Sinus Rhythm DCCV or Catheter Ablation Efficacy defined as freedom from AF

4 Symptoms of Atrial Fibrillation

5 Background to AFEQT Although stroke prevention, rate, and rhythm control are important goals of AF treatment, minimizing symptoms, physical limitations, and the quality-of-life (QoL) decrements associated with AF are equally important Atrial Fibrillation (AF) has a detrimental impact on health-related quality -of-life (QOL) Measuring this outcome can be difficult What is required is a comprehensive, validated AF specific questionnaire to measure the spectrum of QOL domains affected by AF

6 QOL Assessment Tools Short Form Heart Survey: SF-36 Generalized Anxiety Disorder: GAD-7 EuroQOL: EQ-5D Atrial Fibrillation Severity Scale: AFSS These Assessment tools do not capture the disease impact on patients' physical and emotional function.

7 A simple way to measure the effect of AF on symptoms and QOL: Severity of Atrial Fibrillation (SAF) Class Class 0 = Asymptomatic with respect to AF Class 1 = Symptoms attributable to AF have minimal effect on patient s general QoL Class 2 = a minor effect on patient s general QoL Class 3 = a moderate effect on patient s general QoL Class 4 = a severe effect on patient s general QoL Dorian P, Cvitkovic SS, Kerr CR; et al. Can J Cardiol. 2006; 22(5): Dorian P, et al. Circ Arrhythmia Electrophysiol

8 AFEQT To address this gap, the Atrial Fibrillation Effect on QualiTy-of-life (AFEQT) questionnaire, has been developed to explicitly measure patients' perceptions of their symptoms, functional impairment, treatment concerns, and satisfaction with treatment.

9 AFEQT 214 participants 77 Underwent AF Ablation Group 3 68 stable (no change in treatment) Group 1 68 received change in medication Group 2

10 AFEQT-Questionnaire Initially 42 questions Questionnaire completed at Baseline, 1 month and 3 month Average completion time 9.3 minutes Average 94% completion rates Mean age 62 years 58% male & 42% female

11 AFEQT- 20 Questions 4 Questions Symptoms Score 8 Questions Daily Activities Score Score 1 to 7 6 Questions Treatment Concern Score 2 Questions Treatment Satisfactory Score

12 Baseline and Follow-Up AFEQT Domain Scores for Treatment Group 1 (no change in treatment) AFEQT Global Score (SD) Symptoms Treatment Concern Daily Activities Treatment Satisfaction Baseline 3 Month Change From Baseline

13 Baseline and Follow-Up AFEQT Domain Scores for Treatment Group 2 (change in medication) AFEQT Global Score (SD) Symptoms Treatment Concern Daily Activities Treatment Satisfaction Baseline 3 Month Change From Baseline

14 Baseline and Follow-Up AFEQT Domain Scores for Treatment Group 3 (AF ablation) AFEQT Global Score (SD) Symptoms Treatment Concern Daily Activities Treatment Satisfaction Baseline 3 Month Change From Baseline

15 AFEQT AF-specific questionnaires, like AFEQT, allow patients to quantify their limitations and the extent to which they are attributable to a specific disease. Future work applying the AFEQT in a variety of applications will enable patients' experiences of their AF, and its treatment, to be a foundation for a more thorough understanding of how best to elevate the efficacy of AF therapy and the quality of caring for AF patients.

16 AFEQT Thank You!