A significant number of patients with atrial fibrillation (AFib) are not receiving the care they need because their symptoms were not properly evaluated, according to a new study published in JACC: Clinical Electrophysiology. What can be done to reverse this trend and match more patients with a beneficial treatment plan?
“Current clinical guidelines and expert statements recommend catheter ablation in patients with symptomatic AFib,” explained lead author Yoshinori Katsumata, MD, PhD, a cardiologist at Keio University School of Medicine in Tokyo, and colleagues. “In particular, the recommendations indicate AFib ablation as a first-line therapy or a second-line therapy after the failure of Class I or III antiarrhythmic agents. However, to optimally manage patients’ symptom burdens, physicians must first accurately assess the presence and frequency of their symptoms. The symptom burden of a patient with AFib is often assessed via medical interviews by physicians, which has inherent limitations, including preexisting biases and time constraints on the part of both the physicians and the patients.”
To learn more about this crucial topic, Katsumata et al. explored data from more than 3,200 AFib patients treated in Japan from 2012 to 2017. Each patient underwent an AFib symptom burden assessment—known as the Atrial Fibrillation Effect on Quality-of-Life (AFEQT) questionnaire—when they were treated. More than 1,100 of those patients had an AFEQT score of 80 or more, suggesting they have symptomatic AFib.
Overall, 39% of patients with an AFEQT score of 80 or more underwent catheter ablation for their symptomatic AFib. Patients in the ablation group had an average age of 63 years, and 69% were male. Among patients with an AFEQT score of 80 or more who did not undergo ablation, the average age was 72 years old, and 56% were male. Paroxysmal AFib was also more common among patients in the ablation group.
After one year, patients in the ablation group had more improvement in their AFEQT scores than patients who did not undergo ablation. This was true even after making adjustments as necessary for a variety of “clinically relevant factors.”
The authors found that 28% of patients met the criteria for symptom under-recognition—and this was “significantly associated” with patients not undergoing catheter ablation.
“We found that whether or not a patient received catheter ablation did not depend on the severity of symptoms, but rather it depended on whether or not the patient’s physician appropriately recognized the patient’s symptoms,” the authors wrote. “Patients whose symptoms were under-recognized were 0.42 times less likely to undergo catheter ablation than were patients whose symptoms were appropriately recognized. This finding was also observed in symptomatic patients age ≤75 years or those with paroxysmal AFib.”
Katsumata and colleagues emphasized that improved standardization when treating AFib patients and the consistent use of questionnaires could “potentially facilitate and improve patient outcomes.”
“Further studies, including randomized controlled trials, are needed to examine the long-term impact of symptom under-recognition in terms of its association with catheter ablation and improvement in quality of life,” they concluded.
Read the full analysis here.
Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.