The Combined Effects of Patient Activation and Relational Aspects on the Quality of Life in Atrial Fibrillation Patients

Impact of Ablation Energy Sources on Perceived Quality of Life and Symptom in Atrial Fibrillation Patients: A Comparative Study

Background: Catheter ablation is a first-line treatment for rhythm control strategies in patients with atrial fibrillation (AF), with different energy sources available, including pulsed-field ablation (PFA), high-power short-duration radiofrequency (HPSD RF), conventional radiofrequency (RF), and cryoballoon ablation. Limited evidence exists on how different ablation techniques affect patient-reported outcomes, such as patients' quality of life (QoL) and perceived symptoms. This study aims to assess the impact of ablation energy sources on reported QoL and symptom perception after AF ablation. Methods: The study included 148 patients who underwent catheter ablation in different centers. Patients were divided into four groups according to the energy source used. Follow-up was conducted during the 6 months post-procedure. Patients were asked to complete a 20-item questionnaire evaluating quality of life, activity resumption, recovery process, perceived symptoms, and satisfaction. Comparative analyses were performed across energy groups, anesthesia types, and anesthetic drugs. Results: PFA patients reported the highest improvement in QoL scores compared to RF, HPSD RF, and cryoablation (p < 0.001). Activity resumption and symptom relief were significantly better in the PFA group compared to others (p < 0.001). Anesthesia type and anesthetic drug influenced QoL outcomes, with patients under general anesthesia showing higher QoL scores compared to deep sedation (p < 0.001). The energy source and anesthetic drug resulted in independent predictors of QoL improvement. Conclusions: Ablation energy source could impact patients' perceived QoL and symptom relief after AF ablation. PFA demonstrated superior performance scores in QoL and symptom perception compared to other techniques. Anesthetic drugs also play a role in patient-reported outcomes and activity resumption.

The Impact of Quality of Life on Cardiac Arrhythmias: A Clinical, Demographic, and AI-Assisted Statistical Investigation

Background/Objectives: Cardiac arrhythmias impact quality of life (QoL) and are often linked to psychological distress. This study examines the relationship between QoL, depression, and arrhythmias using AI-assisted analysis to enhance patient management. Methods: A total of 145 patients with arrhythmias were assessed using an SF-36 health survey (QoL) and a PHQ-9 questionnaire (depression). Statistical analyses included regression, clustering, and AI-based models such as K-means and logistic regression to identify risk factors and patient subgroups. Results: Patients with comorbidities had lower QoL and higher depression scores. PHQ-9 scores negatively correlated with SF-36 mental health components. AI-assisted clustering identified distinct patient subgroups, with older individuals and those with longer disease duration exhibiting the lowest QoL. Logistic regression predicted depression with 93% accuracy, and XGBoost achieved an AUC of 0.97. Conclusions: QoL plays a key role in arrhythmia management, with depression significantly influencing outcomes. AI-driven predictive models offer personalized interventions, improving early detection and treatment. Future research should integrate wearable technology and AI-based monitoring to optimize patient care.

Factors Associated with Quality of Life among People with Atrial Fibrillation: Jordan Atrial Fibrillation Registry Study

Background and Objectives: Atrial fibrillation (AF) is a common arrhythmia that may adversely affect the quality of life (QoL). Several factors could be associated with the QoL among patients with AF; however, evidence regarding these factors is still limited and controversial. Therefore, this study aimed to identify the level of QoL and its associated factors among Jordanian patients with AF. Subjects and methods: A case study design was implemented. A sample of 620 participants were recruited from 28 outpatient clinics registered in the Jordan atrial fibrillation registry AF (JoFIB). Data on QoL were gathered through the self-reported Atrial Fibrillation Effect on Quality-of-life tool (AFEQT). A QoL questionnaire was validated in this population before starting this study. The cardiac nurse then provided the research assistant with data relating to patients' characteristics and associated comorbidities. Results: The overall AFEQT scores were positively skewed (median 21.3, IQR: 14.4-31.9). This pattern was reflected for the AFEQT sub-scales 'Symptoms' (20.8, 8.3-33.3), 'Daily activities' (16.7, 10.4-27.1), and 'Treatment concerns' (27.8, 19.4-41.7), whereas 'Treatment satisfaction' was negatively skewed (91.7, 83.3-91.7). Patients in the higher quartiles, indicating a better QoL, tended to be younger and were less likely to experience dyslipidemia, stroke, pulmonary hypertension, or other comorbidities. Over 90% of patients were currently experiencing AF, and patients with a better QoL tended to be less likely to be currently experiencing AF and more likely to have had their latest episode of AF more than a month ago (compared to less than a month ago). Age, BMI, dyslipidemia, heart failure, COPD, CAD, history of ablation, and the use of anticoagulants were significantly associated with the overall AFEQT score (R2 = 0.278). Conclusions: This study demonstrates that AF Jordanian patients had low levels of QoL. Patients in higher quartiles for the overall AFEQT score were younger, with fewer disease comorbidities and less experience of current AF episodes. Several modifiable and non-modifiable factors were associated with QoL in AF patients. Age, BMI, dyslipidemia, heart failure, COPD, CAD, history of ablation, and the use of oral anticoagulants were significantly associated with the overall AFEQT score. Healthcare providers should target these factors as indicators or interventions for which QoL is continuously monitored.

Educational Needs of People Living with Atrial Fibrillation: A Qualitative Study

Background This study explored the educational and self-management needs of adults living with atrial fibrillation (AF). Methods and Results This is a qualitative study of adults living with AF, clinicians, and expert key stakeholders. Interviews were conducted via a one-to-one semistructured videoconference or phone and transcribed verbatim for thematic analysis. A total of 34 participants were recruited and included in analyses (clinicians n=13; experts n=13, patients n=8). Interviews were on average 40 (range 20-70) minutes in duration. Three key themes were identified: (1) "Patient-centered AF education"; (2) "Prioritizing AF education"; and (3) "Timing AF education." The availability of credible information was perceived as highly variable. Information primarily focused on anticoagulation, or procedural information, as opposed to other aspects of management, such as risk factor reduction. Factors to optimize learning, such as multimedia, apps, case studies, or the use of visuals were perceived as important. Continuity of care, including engagement of caregivers, was important to help develop relationships, and facilitate understanding, while concurrently creating opportunities for timely targeted education. Clinicians described acute care as a suboptimal setting to deliver education. Competing interests aligned with the time-pressured context of acute care were prioritized over patient education. In contrast, patients valued continuity of care. AF education strategies need to pivot from a "one size fits all" approach and modernize to implement a range of approaches. Conclusions There remain many unmet needs in the provision of quality AF education to support self-management. Multimodal offerings and the ability to tailor to individual patient needs are important design considerations for new education programs.