Quality of life after screening for atrial fibrillation: a substudy from a randomised screening trial

Abstract Background Screening for atrial fibrillation (AF) is rising, yet trials have failed to show efficacy for stroke prevention from screening and subsequent anticoagulation. Quality of life is an important outcome for patients and physicians, however, it is largely unknown how this outcome is affected by screening for AF. The adverse effects of screening should be considered before implementing systematic screening. Purpose To explore changes in quality of life associated with screening for AF and subsequent anticoagulant treatment upon AF detection. Methods We used quality of life data from 6,004 persons with stroke risk factors randomised to usual care (n=4,503) or screening for AF using implantable loop recorder and anticoagulation for AF episodes lasting ≥6 minutes (n=1,501). The validated EQ-5D-5L tool evaluates health-related quality of life in five domains (mobility, selfcare, usual activities, pain/discomfort and anxiety/depression), rendering a final score in EQ-index (worst=-0.76 best=1.00) combined with an EQ-VAS score (worst=0, best=100). EQ-index and EQ-VAS were analysed with linear mixed models from baseline through year three. The domains were also analysed with logistic regression to report the risk of major problems (defined as a rating of 3, 4, or 5 in the range [1-5], where 1 corresponds to no problem and 5 corresponds to an extreme problem within a given domain) overall and separately. Sensitivity analyses with imputation for missing data were performed. Results Data were available for 5,162 (86.0%) participants at baseline and in year three, and 227 (5.0%) in usual care and 65 (4.3%) in the screened group had died before the last assessment. At baseline, 1,202 of 5,162 (23.3%) participants reported major pain/discomfort problems, and 666 of 5,162 (12.9%) reported major mobility problems (Figure 1). Major selfcare problems were the least frequent problem reported by 83 of 5,162 participants (1.6%). The occurrence of major problems was increased after 3 years in all domains and in both randomisation groups, with a 2% higher occurrence of major pain/discomfort in the control group compared to the screened group. At baseline, the average EQ-index was 0.88 (±0.16) and EQ-VAS 78.4 (±16.2). After three years, the EQ-index decreased by -0.05 (-0.05; -0.04), p<0.0001 in the control group vs. -0.04 (-0.05; -0.02) in the screened group and EQ-VAS with -6.06 (-6.54; -5.57) in the control group vs. -5.18 (-6.52; -3.78) in the screened group, resulting in no statistically significant difference between the groups (p=0.063 and p=0.056) (Figure 2). The screened group was equally likely to report at least one major problem in quality of life after three years (odds ratio 0.93 (0.77;1.13)), but was less likely to report major pain/discomfort (odds ratio 0.84 (0.72;0.98)), compared with the control group. Conclusion Systematic and intensive screening for atrial fibrillation did not improve quality of life compared to usual practice.