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The European Heart Rhythm Association symptom classification for atrial fibrillation: validation and improvement through a simple modification

Europace (London, England), 2014-07, Vol.16 (7), p.965-972 [Peer Reviewed Journal]

The Author 2014. Published by Oxford University Press on behalf of the European Society of Cardiology. ;The Author 2014. Published by Oxford University Press on behalf of the European Society of Cardiology. 2014 ;ISSN: 1099-5129 ;EISSN: 1532-2092 ;DOI: 10.1093/europace/eut395 ;PMID: 24534264

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Title:
The European Heart Rhythm Association symptom classification for atrial fibrillation: validation and improvement through a simple modification
Author: Wynn, Gareth J ; Todd, Derick M ; Webber, Matthew ; Bonnett, Laura ; McShane, James ; Kirchhof, Paulus ; Gupta, Dhiraj
Subjects: Aged ; Atrial Fibrillation - classification ; Atrial Fibrillation - diagnosis ; Atrial Fibrillation - economics ; Atrial Fibrillation - physiopathology ; Atrial Fibrillation - psychology ; Atrial Fibrillation - therapy ; Clinical Research ; Cost-Benefit Analysis ; Discriminant Analysis ; Female ; Health Care Costs ; Health Resources - economics ; Health Resources - utilization ; Health Status ; Health Status Indicators ; Humans ; Male ; Middle Aged ; Predictive Value of Tests ; Prognosis ; Prospective Studies ; Quality of Life ; Reproducibility of Results ; Retrospective Studies ; Surveys and Questionnaires
Is Part Of: Europace (London, England), 2014-07, Vol.16 (7), p.965-972
Description: To validate the European Heart Rhythm Association (EHRA) symptom classification in atrial fibrillation (AF) and test whether its discriminative ability could be improved by a simple modification. We compared the EHRA classification with three quality of life (QoL) measures: the AF-specific Atrial Fibrillation Effect on QualiTy-of-life (AFEQT) questionnaire; two components of the EQ-5D instrument, a health-related utility which can be used to calculate cost-effectiveness, and the visual analogue scale (VAS) which demonstrates patients' own assessment of health status. We then proposed a simple modification [modified EHRA (mEHRA)] to improve discrimination at the point where major treatment decisions are made. quality of life data and clinician-allocated EHRA class were prospectively collected on 362 patients with AF. A step-wise, negative association was seen between the EHRA class and both the AFEQT and the VAS scores. Health-related utility was only significantly different between Classes 2 and 3 (P < 0.001). We developed and validated the mEHRA score separating Class 2 (symptomatic AF not limiting daily activities), based on whether the patients were 'troubled by their AF' (Class 2b) or not (Class 2a). This produced two distinct groups with lower AFEQT and VAS scores and, importantly, both clinically and statistically significant lower health utility (Δutility 0.9, P = 0.01) in Class 2b than Class 2a. Based on patients' own assessment of their health status and the disease-specific AFEQT, the EHRA score can be considered a useful semi-quantitative classification. The mEHRA score has a clearer separation in health utility to assess the cost efficacy of interventions such as ablation, where Class 2b symptoms appear to be the appropriate treatment threshold.
Publisher: England: Oxford University Press
Language: English
Identifier: ISSN: 1099-5129
EISSN: 1532-2092
DOI: 10.1093/europace/eut395
PMID: 24534264
Source: Geneva Foundation Free Medical Journals at publisher websites
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The European Heart Rhythm Association symptom classification for atrial fibrillation: validation and improvement through a simple modification

The Author 2014. Published by Oxford University Press on behalf of the European Society of Cardiology. ;The Author 2014. Published by Oxford University Press on behalf of the European Society of Cardiology. 2014 ;ISSN: 1099-5129 ;EISSN: 1532-2092 ;DOI: 10.1093/europace/eut395 ;PMID: 24534264

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