Is health-related quality of life a predictor of hospitalization or mortality among women or men with atrial fibrillation?

Pubmed ID: 24165699

Journal: The Journal of cardiovascular nursing

Publication Date: Nov. 1, 2014

Affiliation: Deborah W. Chapa, PhD, ACNP-BC Assistant Professor, School of Nursing, George Washington University, Washington, DC. Bimbola Akintade, PhD, ACNP-BC, MBA, MHA Assistant Professor, School of Nursing, University of Maryland, Baltimore. Eleanor Schron, PhD, RN, FAAN, FSCT Director, Clinical Applications, Vision Research Program, Division of Extramural Research, National Eye Institute/National Institutes of Health, Bethesda, Maryland. Erika Friedmann, PhD Professor, School of Nursing, University of Maryland, Baltimore. Sue A. Thomas, PhD, RN, FAAN Professor, School of Nursing, University of Maryland, Baltimore.

MeSH Terms: Humans, Male, Female, Aged, Aged, 80 and over, Risk Factors, Middle Aged, Proportional Hazards Models, Sex Factors, Atrial Fibrillation, Hospitalization, Follow-Up Studies, Quality of Life, Predictive Value of Tests, Health Status

Authors: Schron E, Friedmann E, Thomas SA, Chapa DW, Akintade B

Cite As: Chapa DW, Akintade B, Schron E, Friedmann E, Thomas SA. Is health-related quality of life a predictor of hospitalization or mortality among women or men with atrial fibrillation? J Cardiovasc Nurs 2014 Nov-Dec;29(6):555-64.

Studies:

Abstract

BACKGROUND: Little is known about predictors of mortality or hospitalization in women compared with men in patients with atrial fibrillation (AF). Although there are established gender differences in patients with coronary artery disease (CAD), differences have not been established in AF. OBJECTIVES: The aim of this study was to examine clinical and health-related quality of life (HRQOL) predictors of mortality and 1-year hospitalization in women compared with men with AF. METHODS: Limited-use data from the National Institutes of Health/National Heart, Lung, and Blood Institute Atrial Fibrillation Follow-up Investigation of Rhythm Management clinical trial provided the sample of 693 patients with AF, 262 women and 431 men. Clinical predictors examined were heart failure (HF), CAD, left ventricular ejection fraction, diabetes, stroke, and age. Predictors of HRQOL included overall HRQOL (Medical Outcomes Study Short Form-36 physical [PCS] and mental component scores) and cardiovascular HRQOL using Quality of Life Index-Cardiac Version. RESULTS: Mortality did not differ (women, 11.4%; men, 14.5%; χ(2)1 = 0.437, P = .509) according to gender, with mean 3.5-year follow-up. Different variables independently predicted mortality for women and men. For women, diabetes (hazard ratio [HR], 3.415; P = .003), HF (HR, 2.346; P = .027), stroke (HR, 2.41; P = .032), and age (HR, 1.117; P = .002), and for men, CAD (HR, 1.914; P = 02), age (HR, 1.103, P = < .001), worse PCS (HR, 1.089, P = .001), and worse Quality of Life Index-Cardiac Version score (HR, 1.402, P = .025) independently predicted mortality.One-year hospitalization (women, 38.9%; men, 36.4%) did not differ by gender (χ(2)1 = 0.914, P = .339). Different variables independently predicted 1-year hospitalization-for women: diabetes (odds ratio [OR], 2.359; P = .022), worse PCS (OR, 1.070; P = .003), and rhythm control trial arm (OR, 2.111; P = .006); for men: HF (OR, 2.072; P = .007), worse PCS (OR, 1.045; P = .019), living alone (OR, 1.913; P = .036), and rhythm control trial arm (OR, 2.113; P < .001). CONCLUSION: Only clinical status predicted mortality among women; HRQOL and clinical status predicted mortality among men. Both clinical and HRQOL variables predicted hospitalization for women and men. Increased monitoring of HRQOL and interventions designed to target the clinical and HRQOL predictors could impact mortality and hospitalization. Nursing interventions may prove effective for modifying most of the predictors of mortality and hospitalization for women and men with AF.