Abstract 15347: Symptom Status and Treatment Strategy in Contemporary Management of Atrial Fibrillation: Findings From the ORBIT-AF Registry
Background: One goal of atrial fibrillation (AF) management is to control patient symptoms and improve quality of life. We analyzed AF symptom burden and treatment strategies in contemporary practice.
Methods: The Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) is a large longitudinal registry of AF in US ambulatory practice. Characteristics of those enrolled were compared according to symptom burden as defined by the European Heart Rhythm Association (EHRA) classification.
Results: Among 5410 AF patients from 138 US sites, the mean age was 74 ± 11, 42% were female, and the mean CHADS2 score was 2.3 ± 1.3. At baseline, 39% of patients (n=2,120) had no symptoms (EHRA Class I), 46% (n=2025) had mild symptoms (Class II), and 15% (n=785) had severe or disabling symptoms (Class III or IV). Symptoms most commonly reported were palpitations (32%), dyspnea on exertion (28%), and fatigue (26%). Symptomatic AF (EHRA Class ≥ 2) was more common in younger patients, women, those with frailty, thyroid disease, obstructive sleep apnea, COPD, familial AF, sinus node dysfunction, and heart failure (Table). The mean heart rate was greater in those with symptoms. Paroxysmal AF was more common in those with symptomatic AF (Table). Rhythm control was employed in 33% of those with symptoms versus 27% in asymptomatic patients (p<.0001). Beta-blocker, nondihydropyridine calcium channel blocker, and digoxin use were all more common in those with symptoms (p<.05 for all). There was no difference in prior cardioversions, while antiarrhythmic therapy was more common in those with symptoms (Table). Finally, catheter ablation of AF was used rarely in both symptomatic and asymptomatic patients (5.4 vs. 3.5%, p<.001).
Conclusions: A majority of AF patients in community practice remain symptomatic. Treatment strategies differ only slightly among those with or without symptoms, highlighting the need for improved implementation and more effective therapies.
- © 2011 by American Heart Association, Inc.