Sex differences in health status and rehabilitation outcomes in patients with atrial fibrillation treated with ablation: Results from the CopenHeartRFA trial
Restricted accessResearch articleFirst published online February, 2018
Sex differences in health status and rehabilitation outcomes in patients with atrial fibrillation treated with ablation: Results from the CopenHeartRFA trial
Increased physical capacity after comprehensive rehabilitation in patients with atrial fibrillation (AF) undergoing ablation has been found in the CopenHeartRFA trial. The purpose of this study was to investigate: (a) sex differences in health status, psychological distress and quality of life, (b) sex differences in rehabilitation outcomes and (c) predictors of effect of rehabilitation.
Methods:
We conducted an exploratory analysis of data from the randomized CopenHeartRFA trial, where patients treated with ablation were randomized with 1:1 to comprehensive rehabilitation consisting of a physical exercise program and psycho-educational consultations versus usual care. Sex disparities in health status were tested using Chi-square and t-tests.
Results:
Included were: 151 men (median age 59.25 years) and 59 women (median age 62.5 years). At hospital discharge, women reported lower physical health status compared with men. Among women, significant differences were found in the 6-min walk test [rehabilitation: 496.8 meters (SD 98.5) versus 559.3meters (SD 55.5) and usual care: 521.9 meters (SD 97.8) versus 530.9 meters (SD 102.2), p = 0.01] and exercise time [rehabilitation: 387.6 s (SD 126.0) versus 463.2 s (SD 121.8) and usual care: 353.4 s (SD 145.2) versus 355.8 s (SD 154.8), p < 0.004] and among men in the sit-to-stand test. Significant differences were found in mental health outcomes among men and in quality of life scores among women. Patients with a European Heart Rhythm Association (EHRA) score I-II had a positive effect of rehabilitation.
Conclusion:
The results suggest that sex differences exist in self-reported health after rehabilitation in patients ablated for AF. Patients with an I–II EHRA score seem more likely to gain from the rehabilitation programme compared with those with a III–IV score.
BallJCarringtonMJMcMurrayJJ VStewartS. Atrial fibrillation: Profile and burden of an evolving epidemic in the 21st century. Int J Cardiol2013; 167: 1807–1824.
2.
Zoni-berissoMDomenicucciS. Epidemiology of atrial fibrillation : European perspective. Clin Epidemiol2014; 213–20.
3.
CoyneKMargolisMKGrandySZimetbaumP. The State of Patient-Reported Outcomes in Atrial Fibrillation A Review of Current Measures. Pharmacoeconomics2005; 23: 687–708.
4.
RienstraMLubitzS a.MahidaSMagnaniJWFontesJDSinnerMFet al. Symptoms and functional status of patients with atrial fibrillation: State of the art and future research opportunities. Circulation2012; 125: 2933–2943.
5.
VolgmanASManankilMFMookherjeeDTrohmanRG. Women with atrial fibrillation: Greater risk, less attention. Gend Med Excerpta Medica Inc. 2009; 6: 419–432.
6.
DagresNNieuwlaatRVardasPEAndresenDLévySCobbeSet al. Gender-Related Differences in Presentation, Treatment, and Outcome of Patients With Atrial Fibrillation in Europe. A Report From the Euro Heart Survey on Atrial Fibrillation. J Am Coll Cardiol2007; 49: 572–577.
7.
ForleoGBTondoCDe LucaLDello RussoACasellaMDe SanctisVet al. Gender-related differences in catheter ablation of atrial fibrillation. Europace2007; 9: 613–620.
8.
MertensDJKavanaughT. Exercise training for patients with chronic atrial fibrillation. J Cardiopulm Rehabil199616: 193–6.
9.
HegbomFSireSHeldalMOrningOMStavemKGjesdalK. Short-term Exercise Training in Patients With Chronic Atrial Fibrillation. J Cardiopulm Rehabil2006; 26: 24–29.
10.
OsbakPSMourierMKjaerAHenriksenJHKofoedKFJensenGB. A randomized study of the effects of exercise training on patients with atrial fibrillation. Am Heart J2011;162 :1080–1087.
11.
MalmoVNesBMAmundsenBHTjonnaAStoylenARossvollOet al. Aerobic Interval Training Reduces the Burden of Atrial Fibrillation in the Short Term. Circulation2016; 133: 466–73.
12.
Bjarnason-WehrensBGrandeGLoewelHVöllerHMittagO. Gender-specific issues in cardiac rehabilitation: do women with ischaemic heart disease need specially tailored programmes?Eur J Cardiovasc Prev Rehabil2007; 14: 163–171.
13.
HegbomFStavemKSireSHeldalMOrningOMGjesdalK. Effects of short-term exercise training on symptoms and quality of life in patients with chronic atrial fibrillation. Int J Cardiol2007; 116: 86–92.
14.
McCabePJSchumacherKBarnasonS a. Living with atrial fibrillation: a qualitative study. J Cardiovasc Nur2011; 26: 336–344.
15.
HendriksJMLVrijhoefHJMCrijnsHJGMBrunner-La RoccaHP. The effect of a nurse-led integrated chronic care approach on quality of life in patients with atrial fibrillation. Europace2014; 16: 491–499.
16.
Bjarnason-wehrensBGrandeGLoewelHVoHMittagO. Gender-specific issues in cardiac rehabilitation : do women with ischaemic heart disease need specially tailored programmes ?Eur J Cardiovasc Prev Rehabil2007; 14: 163-171.
17.
J.P. B, G. F, P. D, L. S, S. C, S. H. BACPR scientific statement: British standards and core components for cardiovascular disease prevention and rehabilitation. Heart2013; 99: 1069–1071.
18.
RisomSSZwislerA-DRasmussenTBSibilitzKLMadsenTLSSvendsenJHet al. Cardiac rehabilitation versus usual care for patients treated with catheter ablation for atrial fibrillation: Results of the randomized CopenHeartRFA trial. Am Heart J2016; 181: 120–129.
19.
RisomSSZwislerA-DORasmussenTBSibilitzKLSvendsenJHGluudCet al. The effect of integrated cardiac rehabilitation versus treatment as usual for atrial fibrillation patients treated with ablation: the randomised CopenHeartRFA trial protocol. BMJ Open2013 ;3 :1–14.
20.
PiepoliMFCorràUAdamopoulosSBenzerWBjarnason-WehrensBCupplesMet al. Secondary prevention in the clinical management of patients with cardiovascular diseases. Core components, standards and outcome measures for referral and delivery: A Policy Statement from the Cardiac Rehabilitation Section of the European Association for. Eur J Prev Cardiol; 21: 664–681.
21.
BorgG. Ratings of perceived exertion and heart rates during short-term cycle exercise and their use in a new cycling strength test. Int J Sports Med1982; 3: 153–158.
22.
ParseRR. The Human Becoming Theory: The Was, Is, and Will be. Vol. 10, Nursing Science Quarterly. 1997. p. 32–8.
23.
CammaJKirchhofPLipGYHSchottenUSavelievaIErnstSet al. Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J; 31: 2369–2429.
24.
CammAJLipGYHDe CaterinaRSavelievaIAtarDHohnloserSHet al. 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association. Eur Heart J2012; 33(1522-9645 (Electronic)): 2719–2747.
25.
ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med2002; 166: 111–117.
26.
JonesCJRikliREBeamWC. A 30-s chair-stand test as a measure of lower body strength in community-residing older adults. Res Q Exerc Sport1999; 70: 113–119.
27.
BergSKPedersenPUZwislerA-DWinkelPGluudCPedersenBDet al. Comprehensive cardiac rehabilitation improves outcome for patients with implantable cardioverter defibrillator. Findings from the COPE-ICD randomised clinical trial. Eur J Cardiovasc Nurs2014; 5; 1–11.
28.
WareJESherbourneCD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care1992; 30: 473–83.
29.
JohnstonMPollardBHennesseyP. Construct validation of the hospital anxiety and depression scale with clinical populations. J Psychosom Res2000; 48: 579–84.
30.
BambauerKZLockeSEAupontOMullanMGMcLaughlinTJ. Using the Hospital Anxiety and Depression Scale to screen for depression in cardiac patients. Gen Hosp Psychiatry2005; 27: 275–84.
31.
van DijkMRUtensEMDulferKAl-QezwenyMNvan GeunsR-JDaemenJet al. Depression and anxiety symptoms as predictors of mortality in PCI patients at 10 years of follow-up. Eur J Prev Cardiol2015; 23: 552-558.
32.
AriansenIDammenTAbdelnoorMTveitAGjesdalK. Mental health and sleep in permanent atrial fibrillation patients from the general population. Clin Cardiol2011; 34: 327–331.
33.
SnaithRP. The Hospital Anxiety And Depression Scale. Health Qual Life Outcomes1983; 1: 29.
34.
SpertusJDorianPBubienRLewisSGodejohnDReynoldsMRet al. Development and validation of the Atrial Fibrillation Effect on QualiTy-of-life (AFEQT) questionnaire in patients with Atrial Fibrillation. Circ Arrhythmia Electrophysiol2011; 4: 15–25.
35.
DorianPBurkCMullinCMBubienRGodejohnDReynoldsMRet al. Interpreting changes in quality of life in atrial fibrillation: How much change is meaningful?Am Heart J2013; 166: 381–7.e8.
36.
BittnerVSandersonB. Women in cardiac rehabilitation. J Am Med Womens Assoc58: 227–235.
37.
PaquetteMRoyDTalajicMNewmanDCouturierAYangCet al. Role of gender and personality on quality-of-life impairment in intermittent atrial fibrillation. Am J Cardiol2000; 86: 764–768.
ReedJLMarkAEReidRDPipeAL. The effects of chronic exercise training in individuals with permanent atrial fibrillation: a systematic review. Can J Cardiol29: 1721–1728.
40.
PippaLManzoliLCortiICongedoGRomanazziLParrutiG. Functional capacity after traditional Chinese medicine (qi gong) training in patients with chronic atrial fibrillation: a randomized controlled trial. Prev Cardiol2007; 10: 22–25.
41.
GroenveldHFCrijnsHJGMVan Den BergMPVan SonderenEAlings a.MTijssenJGPet al. The effect of rate control on quality of life in patients with permanent atrial fibrillation: Data from the race II (Rate Control Efficacy in Permanent Atrial Fibrillation II) study. J Am Coll Cardiol2011; 58: 1795–1803.
42.
AtwoodJEMyersJNTangXCRedaDJSinghSNSinghBN. Exercise capacity in atrial fibrillation: A substudy of the Sotalol-Amiodarone Atrial Fibrillation Efficacy Trial (SAFE-T). Am Heart J2007; 153: 566–572.
43.
KirchhofPBenussiSKotechaDAhlssonAAtarDCasadeiBet al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur J Cardio-Thoracic Surg2016; 1–88.
