Redefining atrial fibrillation treatment success: patient-defined goals for arrhythmia burden and health-related quality of life.
BACKGROUND Despite the use of atrial fibrillation (AF) cutoff of 30s as the standard for success in most AF clinical trials, patients consider an AF Severity Scale (AFSS) of ≤ 5 or AF duration ≤ 1 hour as treatment success. Prevalence and factors associated with these patient-defined endpoints are unknown. METHODS We performed a cross-sectional analysis using a single-site cohort of AF patients. We report rates of patient-defined treatment success (AFSS ≤ 5 or AF burden ≤ 1 hour) and multivariable analyses to identify factors associated with either successful outcome. RESULTS From 2019 to 2023, 2087 patients had available AFSS symptom scores and 2305 had ambulatory ECG monitoring. Of these, 862 (41%) had AFSS scores ≤5 and 1130 (49%) had AF burden ≤1 hour. After adjusted analysis, older age (OR 1.03, 95% CI 1.02-1.04, p <0.001) was associated with AFSS ≤5. Whereas female sex (OR 0.43, 95% CI 0.35-0.52, p <0.001), CKD, COPD, depression, and CHF were less likely to meet AFSS threshold. Among the AF burden cohort, age (OR 0.98, 95% CI 0.97-0.99, p <0.001), and female sex (OR 1.24, 95% CI 1.03-1.50, p=0.025) were associated with AF burden ≤ 1 hour. Unlike the AFSS cohort, medical comorbidities such as COPD and CHF, were not significantly different for meeting AF burden goal. CONCLUSION Less than half of AF patients had AF-symptom scores or arrhythmia burdens reflecting patient-defined treatment success. Factors associated with reaching patient reported outcome goals were distinct from those associated with arrhythmia burden goals.