Interpreting changes in quality of life in atrial fibrillation: How much change is meaningful?

Dorian, Paul; Burk, Caroline; Mullin, Christopher M.; Bubien, Rosemary; Godejohn, Donna; Reynolds, Matthew R.; Lakkireddy, Dhanunjaya R.; Wimmer, Alan P.; Bhandari, Anil; Spertus, John

doi:10.1016/j.ahj.2013.04.015

Cited by 95Atrial Fibrillation Management and OutcomesHealth Education and ValidationHealth Systems, Economic Evaluations, Quality of Life

Interpreting changes in quality of life in atrial fibrillation: How much change is meaningful?

Dorian, Paul, Burk, Caroline, Mullin, Christopher M., Bubien, Rosemary, Godejohn, Donna, Reynolds, Matthew R., Lakkireddy, Dhanunjaya R., Wimmer, Alan P. +2 more·2013·American Heart Journal

DOI 10.1016/j.ahj.2013.04.015

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Abstract

Background The Atrial Fibrillation Effect on QualiTy of Life (AFEQT) questionnaire is a novel quality of life (QOL) measure previously shown to be valid, reliable, and sensitive to clinical change in patients with atrial fibrillation (AF). The clinical relevance of a given change in the score is not known. The most useful "anchor" for a measure of meaningful change in QOL is patient-reported magnitude of change.Objective The aim of this study was to define the interpretability of changes in the AFEQT score from the patients' perspective.Methods With the use of the original validation study of AFEQT, in which 210 patients completed the questionnaire at baseline and at 3 months, we estimated the AFEQT score corresponding to a meaningful improvement in QOL using the patients' assessments of global change in QOL, AF symptoms from the Atrial Fibrillation Severity Scale (AFSS), and physicians' assessment of global QOL over the 3 months, as anchors.Results In patients with a moderate improvement in global QOL, the AFEQT scores increased from 51.9 ± 21.8 to 70.8 ± 17.4 (an increase of 18.9 ± 20.7), compared with an increase of 6.9 ± 16.9 units in patients with "unimportant change" in global QOL. Physicians' global assessment yielded a similar change in AFEQT score corresponding to a moderate change in global QOL (21.3 ± 20.2 units). Patients with moderate improvement in AF symptom severity using the AFSS scale had an increase of 17.9 ± 11.8 units on the AFEQT scale. A change in 19 units in the AFEQT score corresponded to a 0.9 SD unit change or greater than a minimal important difference from a distribution based method.Conclusions A meaningful improvement in QOL in patients with AF can be measured from a change in the AFEQT score. These results can assist in monitoring patient progress and interpreting the effects of interventions in patients with AF.

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Assessment of quality of life is constrained by a lack of cross-validation of the several AF-specific quality-of-life tools.
“Assessment of quality of life is further constrained by a lack of cross-validation of the several AF-specific quality-of-life tools.”
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Method
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Result
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BackgroundInfluential
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BackgroundMethod
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Background
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Background
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“An improvement of approximately 20 points in total AFEQT score, as observed in this study, has previously been shown to correlate with improvement on the Patient Global Change assessment.(19) This improvement in AFEQT score was also accompanied with a 33% reduction in the Class I/III AAD usage at 12 months compared to…”
Result
Cardiac Rehabilitation for Patients Treated for Atrial Fibrillation With Ablation Has Long-Term Effects: 12-and 24-Month Follow-up Results From the Randomized CopenHeartRFA Trial
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ResultInfluential
Atrial fibrillation symptom clusters and associated clinical characteristics and outcomes: A cross-sectional secondary data analysis
Streur, M. M., Ratcliffe, S. J., Callans, D. J., Shoemaker, M. B., & Riegel, B. J. (2018) · European Journal of Cardiovascular Nursing · doi:10.1177/1474515118778445 · Cited by 32 · see citing works
“001 Paroxysmal 479 (48) 286 (58) Persistent 441 (44) 195 (39) Permanent 84 (8) 13 (3) Coronary disease 218 (22) 99 (20) 0.”
Exposure-Based Therapy for Symptom Preoccupation in Atrial Fibrillation: An Uncontrolled Pilot Study
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BackgroundInfluential
The Atrial Fibrillation Therapies after ER visit: Outpatient Care for Patients with Acute AF - The AFTER3 Study.
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Bostrom, J., Saczynski, J. S., Hajduk, A. M., Donahue, K., ROSENTHAL, L. S., Browning, C., Ennis, C., Floyd, K., Richardson, H., Esa, N., et al. (2017) · Critical Pathways in Cardiology A Journal of Evidence-Based Medicine · doi:10.1097/hpc.0000000000000101 · Cited by 24 · see citing works
Impact of adding a video to patient education on quality of life among adults with atrial fibrillation: a randomized controlled trial
Gagné, M. E., Legault, C., Boulet, L., Charbonneau, L., Lemyre, M., Giguere, A. M. C., & Poirier, P. (2019) · Patient Education and Counseling · doi:10.1016/j.pec.2019.03.015 · Cited by 23 · see citing works
Sex differences in health status and rehabilitation outcomes in patients with atrial fibrillation treated with ablation: Results from the CopenHeartRFA trial
Wagner, M. K., Zwisler, A., Risom, S. S., Svendsen, J. H., Christensen, A. V., & Berg, S. K. (2017) · European Journal of Cardiovascular Nursing · doi:10.1177/1474515117720326 · Cited by 23 · see citing works
Paroxysmal and persistent atrial fibrillation ablation outcomes with the pulmonary vein ablation catheter GOLD duty-cycled phased radiofrequency ablation catheter: quality of life and 12-month efficacy results from the GOLD Atrial Fibrillation Registry
Boersma, L. V. A., Koźluk, E., Maglia, G., de Sousa, J., Grebe, O. C., Eckardt, L., Hokanson, R. B., Hemingway, L., Ostern, E., Park, H., et al. (2020) · EP Europace · doi:10.1093/europace/euaa042 · Cited by 22 · see citing works
“Change >_19, meaningful clinical improvement.(20) *P < 0.”
Pulsed field ablation versus conventional thermal ablation for paroxysmal atrial fibrillation: 4-year outcomes in the ADVENT-LTO study
Reddy, V. Y., Gerstenfeld, E. P., Mountantonakis, S., Patel, C. P., Ellenbogen, K. A., Harding, J. D., Gibson, D., Natale, A., Waks, J. W., Calkins, H. G., et al. (2026) · Nature Medicine · doi:10.1038/s41591-026-04246-4 · Cited by 22 · see citing works
“For perspective, a 19-point change in the AFEQT score represents a moderate improvement in quality of life, and a five-point change in the AFEQT score represents a clinically important difference 35,36 .”
Relationship between quality of life and burden of recurrent atrial fibrillation following ablation: CAPCOST multicentre cohort study
Essebag, V., Azizi, Z., Alipour, P., Khaykin, Y., Leong‐Sit, P., SARRAZIN, J., Sturmer, M., Morillo, C. A., Terricabras, M., Amit, G., et al. (2020) · EP Europace · doi:10.1093/europace/euaa066 · Cited by 22 · see citing works
An illness-specific version of the Revised Illness Perception Questionnaire in patients with atrial fibrillation (AF IPQ-R): Unpacking beliefs about treatment control, personal control and symptom triggers
Taylor, E., O'Neill, M. D., Hughes, L. D., & Moss-Morris, R. E. (2017) · Psychology and Health · doi:10.1080/08870446.2017.1373113 · Cited by 23 · see citing works
“It has shown good reliability in AF patients undergoing different treatments, acceptable test–retest reliability and good construct validity in relation to other AF-specific QoL questionnaires (Dorian et al., 2013).”
Result
Health-Related Quality of Life in Patients With Atrial Fibrillation Treated With Catheter Ablation or Antiarrhythmic Drug Therapy: A Systematic Review and Meta-analysis
Allan, K. S., Aves, T., Henry, S., Banfield, L. E., Victor, J. C., Dorian, P., Healey, J. S., Andrade, J. G., Carroll, S. L., & McGillion, M. H. (2020) · CJC Open · doi:10.1016/j.cjco.2020.03.013 · Cited by 22 · see citing works
“One explanation relates to the current limitations of generic HRQL surveys, which measure overall “global change” compared with baseline status.(32) Generic HRQL surveys are effective in assessing general levels of HRQL in a variety of patient populations, but they lack specificity to distinguish between different dis…”
Background
Quality of life after the initial treatment of atrial fibrillation with cryoablation versus drug therapy
Wazni, O. M., Dandamudi, G., Sood, N. A., HOYT, R. H., Tyler, J. D., Durrani, S., Niebauer, M. J., Makati, K. J., Halperin, B. D., Gauri, A. J., et al. (2021) · Heart Rhythm · doi:10.1016/j.hrthm.2021.10.009 · Cited by 21 · see citing works
Atrial fibrillation, quality of life and distress: a cluster analysis of cognitive and behavioural responses
Taylor, E., O'Neill, M. D., Hughes, L. D., & Moss-Morris, R. E. (2021) · Quality of Life Research · doi:10.1007/s11136-021-03006-w · Cited by 20 · see citing works
Clinically Meaningful Change in Quality of Life and Associated Factors Among Older Patients With Atrial Fibrillation
Abu, H. O., Saczynski, J. S., Mehawej, J., Tisminetzky, M. S., Kiefe, C. I., Goldberg, R. J., & McManus, D. D. (2020) · Journal of the American Heart Association · doi:10.1161/jaha.120.016651 · Cited by 18 · see citing works
Positive Clinical Benefit on Patient Care, Quality of Life, and Symptoms After Contact Force–Guided Radiofrequency Ablation in Persistent Atrial Fibrillation
Natale, A., Calkins, H. G., Osorio, J., Pollak, S. J., Melby, D. P., Marchlinski, F. E., Athill, C. A., Delaughter, C., Patel, A. M., Gentlesk, P. J., et al. (2020) · Circulation Arrhythmia and Electrophysiology · doi:10.1161/circep.120.008867 · Cited by 18 · see citing works
Body mass index and pulmonary vein isolation: real-world data on outcomes and quality of life
Vermeer, J. R., Houterman, S., Medendorp, N. M., van der Voort, P., Dekker, L., Kuijt, W. J., Driessen, A. H. G., Kemme, M. J. B., van der Voort, P. H., Bhagwandien, R. E., et al. (2024) · EP Europace · doi:10.1093/europace/euae157 · Cited by 18 · see citing works
Dual energy for pulmonary vein isolation using focal ablation technology integrated with a three-dimensional mapping system: SmartfIRE 12-month results
Potter, T. J. R. D., Scherr, D., Pürerfellner, H., Račkauskas, G., Hansen, J., Vijgen, J. M., Phlips, T., Knecht, S., Széplaki, G., Herendael, H. V., et al. (2025) · EP Europace · doi:10.1093/europace/euaf174 · Cited by 17 · see citing works
“44,45 Meaningful improvements were also seen across the AFEQT domain scores of symptoms, daily activities, treatment concerns, and treatment satisfaction, which were observed starting at the 3-month assessment and maintained through 12 months of follow-up.”
Reflections on the usefulness of today’s atrial fibrillation ablation procedure endpoints and patient-reported outcomes
Blomström‐Lundqvist, C., & Wettervik, V. S. (2021) · EP Europace · doi:10.1093/europace/euab318 · Cited by 17 · see citing works
Effects of Ablation Versus Drug Therapy on Quality of Life by Sex in Atrial Fibrillation: Results From the CABANA Trial
Zeitler, E. P., Li, Y., Silverstein, A. P., Russo, A. M., Poole, J. E., Daniels, M. R., Al‐Khalidi, H. R., Lee, K. L., Bahnson, T. D., Anstrom, K. J., et al. (2023) · Journal of the American Heart Association · doi:10.1161/jaha.122.027871 · Cited by 17 · see citing works
Anticoagulation adherence and its associated factors in patients with atrial fibrillation: a cross-sectional study
Chen, P.-T., Wang, T.-J. T., HSIEH, M., Liu, J., Liu, C., Wang, K., & Laio, W.-C. (2019) · BMJ Open · doi:10.1136/bmjopen-2019-029974 · Cited by 17 · see citing works
“It is difficult to compare our findings with other studies because most studies included only patients treated with warfarin27 and used different adherence measures.27 Nevertheless, our study subjects reported relatively good adherence to anticoagulant therapy with an average score of 8.8 (SD=1.9) out of the possible…”
MethodInfluential
Development and Validation of the AFImpact: An Atrial Fibrillation–Specific Measure of Patient-Reported Health-Related Quality of Life
Coyne, K. S., Edvardsson, N. G., & Rydén, A. (2017) · Value in Health · doi:10.1016/j.jval.2017.06.005 · Cited by 16 · see citing works
Differences in Quality of Life Between Atrial Fibrillation Patients with Low Stroke Risk Treated With and Without Catheter Ablation
Bai, Y., Bai, R., Wu, J., Zhang, T., Liu, N., Shi, X., Liu, X., Liu, X., Du, X., Dong, J., et al. (2015) · Journal of the American Heart Association · doi:10.1161/jaha.115.002130 · Cited by 17 · see citing works
Healthcare Utilization and Quality of Life Improvement after Ablation for Paroxysmal AF in Younger and Older Patients
BIVIANO, A. B., Hunter, T. D., Dandamudi, G., Fishel, R., Gidney, B., Herweg, B., Oza, S. R., Patel, A. M., WANG, H., & Pollak, S. J. (2017) · Pacing and Clinical Electrophysiology · doi:10.1111/pace.13041 · Cited by 16 · see citing works
Safety and Effectiveness of a Next-Generation Contact Force Catheter
Lo, M. Y., Sanders, P., Sommer, P., Kalman, J. M., Siddiqui, U., Sundaram, S., Piorkowski, C., Olson, N., Madej, S., & Gibson, D. N. (2021) · JACC. Clinical electrophysiology · doi:10.1016/j.jacep.2021.01.019 · Cited by 14 · see citing works
The Atrial Fibrillation Effect on QualiTy-of-Life (AFEQT) questionnaire: cultural adaptation and validation of the Greek version.
Tailachidis, P., Tsimtsiou, Z., Galanis, P., Theodorou, M., Kouvelas, D., & Athanasakis, K. (2016) · PubMed Central · Cited by 13 · see citing works
Symptom Clusters, Psychological Distress, and Quality of Life in Patients with Atrial Fibrillation
Bang, C. H., & Park, S. (2023) · Healthcare · doi:10.3390/healthcare11091353 · Cited by 12 · see citing works
“When patients with AF experience symptoms, they and their caregivers or supporters face physical and psychological stress, as well as problems in daily and social life, which leads to a lower quality of life [21].”
Background
Atrial fibrillation symptom profiles associated with healthcare utilization: A latent class regression analysis
Streur, M. M., Ratcliffe, S. J., Callans, D. J., Shoemaker, M. B., & Riegel, B. J. (2018) · Pacing and Clinical Electrophysiology · doi:10.1111/pace.13356 · Cited by 12 · see citing works
Factors Associated With Large Improvements in Health-Related Quality of Life in Patients With Atrial Fibrillation
Steinberg, B. A., Holmes, D. N., Pieper, K. S., Allen, L. A., Chan, P. S., Ezekowitz, M. D., Freeman, J. V., Fonarow, G. C., Gersh, B. J., Hylek, E. M., et al. (2020) · Circulation Arrhythmia and Electrophysiology · doi:10.1161/circep.119.007775 · Cited by 12 · see citing works
Pulsed-Field Ablation to Enhance the Durability of Pulmonary Vein Isolation and Treat Paroxysmal Atrial Fibrillation
Reddy, V. Y., Kottkamp, H., Calkins, H. G., Nair, D. G., Sommer, P., Hussein, A. A., Schumacher, B., Dukkipati, S. R., Neužil, P., Oza, S. R., et al. (2026) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2025.10.084 · Cited by 11 · see citing works
Pulsed Field Ablation Versus Sham to Treat Atrial Fibrillation: The PFA-SHAM Randomized Clinical Trial
Osmancik, P. P., Neužil, P., Hozmanová, J., Petrů, J., Heřman, D., Královec, Š., Hozman, M., Tichý, M., Waldauf, P., Karel, T., et al. (2026) · Circulation · doi:10.1161/circulationaha.126.079484 · Cited by 11 · see citing works
Impact of electrical cardioversion on quality of life for patients with symptomatic persistent atrial fibrillation: Is there a treatment expectation effect?
Ha, A. C. T., Stewart, J. A., Klein, G. J., Roy, D., Connolly, S. J., Koren, A., & Dorian, P. (2020) · American Heart Journal · doi:10.1016/j.ahj.2020.05.004 · Cited by 9 · see citing works
Selecting symptom instruments for cardiovascular populations
Zimmerman, L. M., Pozehl, B., Vuckovic, K. M., Barnason, S. A., Schulz, P., Seo, Y., Ryan, C. J., Zerwic, J. J., & DeVon, H. A. (2016) · Heart & Lung · doi:10.1016/j.hrtlng.2016.08.012 · Cited by 9 · see citing works
Lenient rate control versus strict rate control for atrial fibrillation: a protocol for the Danish Atrial Fibrillation (DanAF) randomised clinical trial
Feinberg, J. B., Olsen, M. H., Brandes, A., Raymond, L., Nielsen, W. B., Nielsen, E. E., Steensgaard-Hansen, F., Dixen, U., Pedersen, O. D., Gang, U. J. O., et al. (2021) · BMJ Open · doi:10.1136/bmjopen-2020-044744 · Cited by 7 · see citing works
Contact force catheter ablation for the treatment of persistent atrial fibrillation: Results from the PERSIST‐END study
Lo, M. Y., Nair, D. G., MANSOUR, M. C., Calkins, H. G., Reddy, V. Y., Colley, B. J., Tanaka‐Esposito, C., Sundaram, S., DeLurgio, D. B., Sanders, P., et al. (2022) · Journal of Cardiovascular Electrophysiology · doi:10.1111/jce.15742 · Cited by 7 · see citing works
“It has been estimated that a change in AFEQT score of at least 19 points is very likely to indicate a substantial improvement in QOL.12 In this study, the average improvement from baseline in AFEQT score was 31.6 indicating subjects experienced a significant improvement in their QOL beginning shortly after their index…”
BackgroundInfluential
Clinical outcomes of a short-term family-focused intervention for patients with atrial fibrillation–A randomised clinical trial
Rosenstrøm, S. M., Risom, S. S., Kallemose, T., Dixen, U., Hove, J. D., & Brødsgaard, A. (2023) · PLoS ONE · doi:10.1371/journal.pone.0282639 · Cited by 6 · see citing works
Changes in cardiac output, rhythm regularity, and symptom severity after electrical cardioversion of atrial fibrillation
Klavebäck, S., Skúladóttir, H., Olbers, J., Östergren, J., & Braunschweig, F. (2023) · Scandinavian Cardiovascular Journal · doi:10.1080/14017431.2023.2236341 · Cited by 6 · see citing works
“The disease specific and validated AFEQT questionnaire has been shown to be internally consistent (Cronbach alpha coefficient > 0.88), and sensitive to the severity of AF and changes over time [9, 24].”
BackgroundInfluential
Discordant Treatment Goals for Patients With Atrial Fibrillation and Clinical Trials Metrics
Zenger, B., Spertus, J. A., Torre, M., Lyons, A., Bunch, T. J., Hess, R., Zhang, Y., Piccini, J. P., Millar, M. M., Lobban, T., et al. (2024) · JACC. Clinical electrophysiology · doi:10.1016/j.jacep.2024.06.026 · Cited by 6 · see citing works
Symptom Network and Clusters of the Multidimensional Symptom Experience in Patients With Atrial Fibrillation
Lin, H., Luo, H., Lin, M. F., Li, H., & Sun, D. (2024) · The Journal of Cardiovascular Nursing · doi:10.1097/jcn.0000000000001133 · Cited by 6 · see citing works
Balloon-in-Basket Pulsed Field Ablation for Pulmonary Vein Isolation
Verma, A., Lo, M. Y., Woods, C. E., Hussein, A. A., Gambhir, A., Sundaram, S., Sanders, P., DeLurgio, D. B., Mountantonakis, S., Neužil, P., et al. (2026) · JACC. Clinical electrophysiology · doi:10.1016/j.jacep.2026.01.006 · Cited by 4 · see citing works
Elimination of Benign Ventricular Premature Beats or Ventricular Tachycardia with Catheter Ablation versus Two Different Optimal Antiarrhythmic Drug Treatment Regimens (Sotalol or Verapamil/Flecainide)
Haanschoten, D. M., Vernooy, K., Beukema, R. J., Szili‐Törok, T., ter Bekke, R. M. A., Khan, M., de Jong, J. S. S. G., Otten, A. M., Adiyaman, A., Smit, J. J. J., et al. (2020) · Cardiology · doi:10.1159/000509661 · Cited by 4 · see citing works
Pulmonary vein isolation versus SHAM-pulmonary vein isolation for symptomatic relief in patients with atrial fibrillation—Design and rationale of the PVI-SHAM-AF trial
Dilk, P., Uhe, T., Forkmann, M., Eckardt, L., Bode, K., Seewöster, T., Gaspar, T., Neef, M., Dinov, B., Bačák, M., et al. (2025) · American Heart Journal · doi:10.1016/j.ahj.2025.06.003 · Cited by 3 · see citing works
Obesity, self-reported symptom severity, and quality of life in people with atrial fibrillation: A community-based cross-sectional survey
Koutoukidis, D. A., Jones, N. R., Taylor, C. J., Casadei, B., & Aveyard, P. N. (2020) · Nutrition Metabolism and Cardiovascular Diseases · doi:10.1016/j.numecd.2020.07.009 · Cited by 3 · see citing works
“The symptom score is a measure of 107 symptom severity in AF patients validated against a clinician-reported measure of QoL in 108 AF, with a 3-point change indicating a clinically significant difference [14, 15].”
Method
Cognitive Behavioral Therapy for Symptom Preoccupation Among Patients With Premature Ventricular Contractions: Nonrandomized Pretest-Posttest Study
Liliequist, B. E., Särnholm, J., Skúladóttir, H., Ólafsdóttir, E., Ljótsson, B., & Braunschweig, F. (2023) · JMIR Cardio · doi:10.2196/53815 · Cited by 3 · see citing works
“The AFEQT has been shown to be sensitive to clinical change, with a change of 18.9 points corresponding to a meaningful improvement as assessed by a physician [19,20].”
MethodInfluential
Cardioversion for Atrial Fibrillation Improves Quality of Life: It's Obvious (or Isn't It?)
Dorian, P., & Ha, A. C. T. (2017) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2017.01.013 · Cited by 3 · see citing works
Long-term effects of radiofrequency ablation on symptom severity, depression, anxiety and quality of life in patients with atrial fibrillation: a longitudinal observational study
Zhu, X., Yin, X., Jiang, S., Wang, M., & Cheng, J. (2025) · BMJ Open · doi:10.1136/bmjopen-2025-100123 · Cited by 2 · see citing works
“The WHOQOL-BREF is a widely used tool for assessing QoL across four domains: physical, psychological, social and environmental, along with two overall QoL items and health perceptions.”
Using Atrial Fibrillation Symptoms to Guide Treatment: Becoming PROs at Improving Quality of Life
Zenger, B., & Steinberg, B. A. (2022) · Current Cardiovascular Risk Reports · doi:10.1007/s12170-022-00695-x · Cited by 2 · see citing works
Whom do you believe? The patient or the ECG?
Dorian, P. (2015) · Heart Rhythm · doi:10.1016/j.hrthm.2015.01.041 · Cited by 2 · see citing works
Atrial Fibrillation Ablation Effectiveness End Points, Safety End Points, and Trial Design: Academic Research Consortium Initiative Endorsed by the Heart Rhythm Society
Wang, P. J., Gerstenfeld, E. P., Piccini, J. P., Verma, A., Bunch, T. J., Blomström‐Lundqvist, C., Tzeis, S. E., Andrade, J. G., Camm, A. J., Chen, L. Y., et al. (2026) · Circulation Arrhythmia and Electrophysiology · doi:10.1161/circep.126.015082 · Cited by 1 · see citing works
Quality of life with atrial fibrillation
Blomström‐Lundqvist, C. (2020) · Elsevier eBooks · doi:10.1016/b978-0-12-817728-0.00048-6 · Cited by 1 · see citing works
24-Hour Holter Monitoring for Identification of an Ideal Ventricular Rate for a Better Quality of Life in Atrial Fibrillation Patients
Sanip, Z., Yusof, Z., Loong, N. S., Naing, N. N., & Isa, W. Y. H. W. (2023) · Cureus · doi:10.7759/cureus.37181 · Cited by 1 · see citing works
“A more AF-specific tool, such as the Atrial Fibrillation Effect on QualiTy of Life (AFEQT), could provide more accurate information [22].”
Method
Atrial Fibrillation in Rural Adults: An Inpatient Evaluation of Clinical Guidelines Adherence
Klug, M. J. (2015) · UA Campus Repository (The University of Arizona)
Cardiac rehabilitation after catheter ablation of atrial fibrilation
Istrătoaie, S., Cismaru, G. L., Roşu, R., Bian, A., Gurzau, D., Frîngu, F. I., Caloian, B., Comşa, H., Marțiș, A., Guşetu, G., et al. (2018) · Balneo Research Journal · doi:10.12680/balneo.2018.208
Atrial Fibrillation a Benign Condition? Quality of Life Approach
Ţică, O., Țica, O., Hatos, A., Pantea-Roșan, L. R., & Popescu, M. I. (2018) · Central European Journal of Clinical Research · doi:10.2478/cejcr-2018-0008
“Assessment of the quality of life is further constrained by a lack of cross-validation of the several AF-specific quality of life tools [12,13].”
Background
Extending physicians’ reach in grasping AF symptoms
Mirwais, M., & Reynolds, M. R. (2020) · American Heart Journal · doi:10.1016/j.ahj.2020.04.012
Measuring “symptomatic” atrial fibrillation: One view is no view
Steinberg, B. A., & Bunch, T. J. (2022) · Heart Rhythm · doi:10.1016/j.hrthm.2022.06.028
Predictors and outcomes of poor health-related quality of life in atrial fibrillation populations
Pierre‐Louis, I. C. (2022) · doi:10.17760/d20474743
Relationships between Symptom Group and Quality of Life in Patients with Atrial Fibrillation: A Cross-Sectional Study
Lei, T. T., & Jiang, F. L. (2023) · ICRRD Quality Index Research Journal · doi:10.53272/icrrd.v4i3.9
“This study used the University of Toronto AF Severity Scale (AFSS) [19]to assess patients' symptoms.”
Influential
Quality of life of patients with structural heart disease undergoing concomitant CryoMaze procedures for persistent atrial fibrillation - randomised comparison of a hybrid approach and CryoMaze alone
Šafaříková, I., Bulava, A., Osmancik, P. P., Wichterle, D., Mokráček, A., Budera, P., Kačer, P., Vetešková, L., Němec, P., Skála, T., et al. (2024) · Kontakt · doi:10.32725/kont.2024.012
Core and bridging symptoms in patients with atrial fibrillation: a network analysis
Sun, D., Yang, X., Li, H., Li, G., & Lin, H. (2025) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2025.1617872
Additional file 1 of Quality of life instruments in atrial fibrillation: a systematic review of measurement properties
Sale, A., & Yu, J. (2022) · Figshare · doi:10.6084/m9.figshare.21351220
Conversational artificial intelligence HeAlth supporT in Atrial Fibrillation Self-Management (CHAT-AF-S): rationale and randomised controlled trial design
Laranjo, L., Zeng, A., O’Hagan, E. T., Trivedi, R., Sathiaraj, R., Thomas, S., Thiagalingam, A., Kovoor, P., Sivagangabalan, G., Kizana, E., et al. (2026) · BMJ Open · doi:10.1136/bmjopen-2026-120834
The effect of integrated lifestyle modification on quality of life and cost-effectiveness in atrial fibrillation ablation: results from the POP-AF RCT
Vermeer, J. R., van Steenbergen, G. J., Vervaat, F. E., Grimm, S. E., van Veghel, D., & Dekker, L. (2026) · European Heart Journal - Quality of Care and Clinical Outcomes · doi:10.1093/ehjqcco/qcag135
Pulmonary Vein Isolation With Contact-Force-Sensing Large-Tip Focal Pulsed Field Ablation Catheter With 3D Mapping for Paroxysmal Atrial Fibrillation: Omny-IRE 12-month Results
Duytschaever, M., Vijgen, J., Neuzil, P., Grimaldi, M., Verma, A., Potter, T. D., Macle, L., Kautzner, J., Linz, D., Anić, A., et al. (2026) · Heart Rhythm · doi:10.1016/j.hrthm.2026.10.008
CATHETER ABLATION VERSUS SHAM FOR SYMPTOMATIC ATRIAL FIBRILLATION: A SYSTEMATIC REVIEW AND BAYESIAN META-ANALYSIS OF RANDOMIZED TRIALS
Kakarla, S., Iwakawa, H., Andrade, J. G., Ariyaratnam, J., Gunawardene, M., Marrouche, N., Middeldorp, M. E., Elliott, A. D., Kistler, P. M., Kalman, J. M., et al. (2026) · Heart Rhythm · doi:10.1016/j.hrthm.2026.10.039

Defining Clinically Important Difference in the Atrial Fibrillation Effect on Quality-of-Life Score
Holmes, D. N., Piccini, J. P., Allen, L. A., Fonarow, G. C., Gersh, B. J., Kowey, P. R., O'Brien, E. C., Reiffel, J. A., Naccarelli, G. V., Ezekowitz, M. D., et al. (2019) · Circulation Cardiovascular Quality and Outcomes · doi:10.1161/circoutcomes.118.005358 · Cited by 111 · see citing works
Development and validation of the Atrial Fibrillation Effect on QualiTy-of-Life (AFEQT) Questionnaire in patients with atrial fibrillation
Spertus, J., Dorian, P., Bubien, R., Lewis, S., Godejohn, D., Reynolds, M. R., Lakkireddy, D. R., Wimmer, A. P., Bhandari, A., & Burk, C. (2011) · Circulation Arrhythmia and Electrophysiology · doi:10.1161/circep.110.958033 · Cited by 485 · see citing works
Development and Validation of the Atrial Fibrillation Effect on QualiTy-of-Life (AFEQT) Questionnaire in Patients With
Fibrillation, A., & Wimmer, A. P. (2016)
Abstract 130: Clinically Important Difference in the Atrial Fibrillation Effect on QualiTy-of-Life (AFEQT) Score: Results from the ORBIT-AF Registry
Simon, D. N., Thomas, L. E., O'Brien, E. C., Fonarow, G. C., Gersh, B. J., Kowey, P. R., Reiffel, J. A., Naccarelli, G. V., Spertus, J. A., Peterson, E. D., et al. (2016) · Circulation Cardiovascular Quality and Outcomes · doi:10.1161/circoutcomes.9.suppl_2.130
COMPARISON OF SYMPTOMS AND QUALITY OF LIFE IN ATRIAL FIBRILLATION: RESULTS FROM THE ORBIT-AF REGISTRY
Piccini, J. P., Holmes, D. N., Thomas, L. E., Fonarow, G. C., Gersh, B. J., Kowey, P. R., Chang, P., Chan, P. S.-F., Spertus, J. A., & Peterson, E. D. (2012) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(12)60622-6 · Cited by 2 · see citing works

Authors: Dorian, P., Burk, C., Mullin, C. M., Bubien, R., Godejohn, D., Reynolds, M. R., Lakkireddy, D. R., Wimmer, A. P., Bhandari, A., & Spertus, J.
Affiliations: St. Michael's Hospital (CA)
University of Alabama at Birmingham (US)
Beth Israel Deaconess Medical Center (US)
The University of Kansas Health System (US)
Good Samaritan Hospital (US)
Corresponding author: Dorian, Paul
ORCID: Dorian, Paul
Burk, Caroline
Reynolds, Matthew R.
Lakkireddy, Dhanunjaya R.
Wimmer, Alan P.
Bhandari, Anil
Spertus, John
Venue: American Heart Journal
Publisher: Elsevier BV
Published: 2013-08
Volume: 166
Issue: 2
Pages: 381-387.e8
ISSN: 0002-8703 (ISSN-L)
DOI: 10.1016/j.ahj.2013.04.015
OpenAlex: W2158493087
Cited by: 95
References: 27
Citations by year: 2026: 9 · 2025: 4 · 2024: 7 · 2023: 8 · 2022: 7 · 2021: 7 · 2020: 18 · 2019: 5 · 2018: 4 · 2017: 11 · 2016: 8 · 2015: 6 · 2014: 1
FWCI: 3.41
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: American Heart Journal (publishedVersion)
PubMed (publishedVersion)
Funders: Heart Rhythm Society
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
Social Sciences › Education › Health Education and Validation
Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
Keywords: atrial fibrillation, quality of life, minimal important difference, meaningful change, patient-reported outcomes, anchor method, symptom severity
MeSH terms: Aged, Atrial Fibrillation, Female, Humans, Male, Middle Aged, Quality of Life, Surveys and Questionnaires, Socioeconomic Factors

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Interpreting changes in quality of life in atrial fibrillation: How much change is meaningful?

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