Abstract
BACKGROUND: Atrial fibrillation (AF) is managed with various strategies, including rate and rhythm control, to improve patients' health status. Although its incidence increases with age, how age affects health status improvements following AF treatment remains unknown. METHODS: Using data from a multicenter registry for outpatients with newly recognized AF, baseline and 1-year health status was assessed with the Atrial Fibrillation Effect on Quality-of-life quesTionnaire (AFEQT). The associations between age and 1-year changes in AFEQT-overall summary and subdomain scores with rate or rhythm control strategies were estimated using generalized additive models. To address nonlinear relationships, we developed multivariable linear regression models with age range categories (<65, 65-75, and ≥75 years). RESULTS: Among 2786 patients (31.7% women); 946 were <65, 1019 were ≥65 to 75, and 821 were ≥75 years, with rate control pursued in 23.4%, 42.0%, and 66.4%, respectively, and their mean 1-year improvements in the AFEQT overall summary were 11.1 (SD: 16.6), 8.0 (17.0), and 4.7 (18.2), respectively. After multivariable adjustment, older age was independently associated with less AFEQT overall summary improvement, regardless of treatment strategy. Patients aged ≥75 years had a smaller AFEQT overall summary improvements than those aged <65 years (difference between groups -3.86 points [-5.29 to -2.42]), primarily driven by smaller improvements in AFEQT daily activities scores with similar improvements in the AFEQT symptoms or treatment concern domains. CONCLUSIONS: Although older adults with AF exhibited smaller gains in functional limitation following disease-specific treatment, they experienced measurable improvements in overall health status regardless of treatment strategies.