Psychische und somatische Aspekte der Lebensqualität bei Patienten mit Vorhofflimmern - eine Gegenüberstellung von Patienten mit Sinusrhythmus, paroxysmalem und persistierendem/permanentem Vorhofflimmern

by Stefan Morawietz
Doctoral thesis
Date of Examination:2023-07-25
Date of issue:2023-07-28
Advisor:Prof. Dr. Christoph Herrmann-Lingen
Referee:Prof. Dr. Christoph Herrmann-Lingen
Referee:Dr. Anja. Sandek
Persistent Address: http://dx.doi.org/10.53846/goediss-10016

 

 

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Abstract

English

It is an empirically well established fact that health-related QoL is reduced in AF patients compared with patients with sinus rhythm. However, less well studied is the question whether the different forms of AF (paroxysmal, persistent, permanent) differ from each other with respect to the QoL associated with them, although in principle this may have important implications for the treatment of these different forms of AF. In addition, many of the existing studies have methodological weaknesses such as the lack of a control group or a cross-sectional design. The present study aimed primarily to investigate the open question of QoL differences between the aforementioned patient groups, thereby avoiding the methodological weaknesses of previous studies. For this purpose, a sample of N = 1589 patients was investigated with regard to associations between psychological (depression, anxiety, vital exhaustion) and physical (including inflammatory parameters/cardiac markers, gender, previous illnesses) variables with the different forms of AF as well as QoL. The results show that AF patients without control of physical function parameters and previous diseases differ only slightly from patients with sinus rhythm with regard to their quality of life (only with regard to vitality). When physical function parameters and preexisting conditions are statistically controlled, this difference is primarily attributable to patients with paroxysmal AF, who have reduced vitality scores compared with patients with SR. In addition, with respect to the SF-36 subscale pain, a significant difference between patients with paroxysmal and persistent/permanent AF is shown, with the latter having higher scores and thus a lower QoL. Several SF-36 variables further approached statistical significance but did not exceed the required significance level. The possibility of a relationship between the form of AF and anxiety and depression was also confirmed, with patients with paroxysmal AF showing higher scores than patients with persistent/permanent AF. It should be noted, however, that the results are not statistically very robust due to the relatively small number of cases. Likewise, it was confirmed that preexisting conditions were associated with a less favorable disease course across the two measurement time points. Finally, the results also show that all forms of AF are more common in men than in women. These results are only partially in line with expectations. This can be explained primarily by the fact that, because of small AF case numbers and the associated, low statistical power, and because of multiple testing, often only statistical trends could be observed. The results are embedded in the current state of knowledge and the practical implication is derived that more weight should be given to psychosocial factors in the diagnosis and treatment of AF.
Keywords: atrial fibrillation
 
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