Correlating Patient-Reported Outcomes and Cardiac Event-Free Survival Time in Patients with Atrial Fibrillation: A Prospective Study

Correlating Patient-Reported Outcomes and Cardiac Event-Free Survival Time in Patients with Atrial Fibrillation: A Prospective Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Correlating Patient-Reported Outcomes and Cardiac Event-Free Survival Time in Patients with Atrial Fibrillation: A Prospective Study Chenglin Zhang, Lu Cai, Hui Sun, Xuemei Li, Xiaoyan Li, Zhifeng Dong This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6415932/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract BACKGROUND— Repeated episodes of atrial fibrillation (AF) can shorten event-free survival time in patients. Patient-reported outcomes (PROs) directly reflect the health status of patients. However, the relationship between PROs and cardiac event-free survival remains unclear. OBJECTIVE— This study aimed to investigate the status of PROs and their correlation with cardiac event-free survival time in patients with AF. METHODS— This study was a prospective study. Patients with non-valvular atrial fibrillation treated in the Department of Cardiology of one three third-class hospital in Yancheng from May 2023 to April 2024 were enrolled. The investigation was performed using general information questionnaire and AF-specific questionnaire 6 (AF6). At baseline, demographic and clinical data of the patients were collected. Major adverse cardiovascular events and one-year event-free survival time after discharge were obtained by telephone follow-ups and review of medical records. RESULTS — Among the 197 patients investigated, the mean age was (74.1 ± 9.0) years old, and 106 (53.8%) were women. The mean AF6 score was (24.29 ± 8.33), with over 50% of patients scoring ≥ 1 point on all six items. A significant correlation was observed between cardiac function grading and PROs (r = 0.360, P < 0.001). Kaplan-Meier plots and log-rank tests demonstrated that patients with poor PROs had significantly worse cardiac event-free survival (P = 0.043). CONCLUSION —The PROs of patients with AF were at a moderate level. Poor PROs were associated with the shorter cardiac event-free survival times. These findings highlight the requirement for intervention studies aimed at improving PROs. Clinical trial number Not applicable. Atrial Fibrillation Patient-Reported Outcomes Event-free Survival Figures Figure 1 Figure 2 INTRODUCTION Atrial fibrillation (AF) is one of the most common persistent arrhythmias, which is also an important cause of morbidity and mortality from cardiovascular disease [ 1 ]. According to the 2020 ESC Guidelines for Diagnosis and Management of Atrial Fibrillation, the prevalence of AF is estimated at 2–4% [ 2 ]. While AF is not directly life-threatening, recurrent symptoms and associated adverse cardiovascular events significantly reduce cardiac event-free survival (CEFS), bringing a huge burden on patients, families and the entire medical resources[ 3 – 5 ]. CEFS refers to the duration of re-hospitalization or death from stable discharge to the next major adverse cardiovascular event (MACE) [ 6 ], while MACE encompasses acute left heart failure, cardiogenic shock, malignant arrhythmia, recurrent angina, AS syndrome and death. Beyond anticoagulation therapy for stroke prevention, increasing attention has been given to the significance of patient-reported outcomes (PROs) in patients with AF [ 7 ]. PROs originated in the 1960s, but studies focusing on PROs in AF only began in this century [ 8 ]. PROs encompass health information, functional levels, and health-related quality of life (HRQoL) [ 9 ]. PROs refer to reports of health status provided directly by patients, without interpretation by healthcare staff or others, emphasizing a patient-centered approach. Numerous regional studies have indicated that PROs play an important role in symptom management, clinical decision-making, and evaluating treatment effectiveness in patients with breast cancer, pancreatic cancer, and chronic obstructive pulmonary disease[ 10 – 12 ]. This study aims to investigate the current status of PROs in AF and to explore their correlation with CEFS.We examined whether the relationship between PROs and CEFS could provide evidence to guide strategies for improving PROs and extending CEFS in patients with AF. Methods Study Design and Participants This prospective, observational study was a secondary analysis involving 197 patients recruited from the inpatient department of a tertiary hospital in China. Patients were eligible for inclusion if they had a confirmed diagnosis of AF, clear awareness, normal communication abilities, and provided informed consent. Patients were excluded if they had cardiac function grade IV, were pregnant or lactating, had malignant diseases (e.g., malignant tumors or hematological disorders), or had severe psychiatric or cognitive impairment unrelated to depression or anxiety. For this study, only patients with complete data on PROs and cardiac events were included. The study received approval from the local Institutional Review Board (IRB). Measurement Cardiac Event-Free Survival Cardiac event-free survival was defined as the composite endpoint representing the time to the first occurrence of one of the following cardiac events from the enrollment date: cardiac emergency department (ED) visits, cardiac hospitalizations, or cardiac mortality. This composite end-point is commonly used in similar research [ 13 – 17 ]. During data collection, the dates and reasons for hospitalization and deaths were noted. Data were collected by trained research assistants with expertise in cardiovascular nursing through patient or family interviews and hospital database records. Patient-Reported Outcomes Symptoms were assessed using the AF-Specific Questionnaire 6 (AF6), a tool that has undergone thorough validation [ 18 ] and clinical responsiveness testing [ 19 ], with a recall period of the past 7 days. The 6-item questionnaire assesses patient-reported AF-related symptoms: (1) “breathing difficulties at rest”; (2) “breathing difficulties upon exertion”; (3) “limitations in day-to-day life due to AF”; (4) “feeling of discomfort due to AF”; (5) “tiredness due to AF”; and (6) “worry/anxiety due to AF.” Each item is scored from 0 (no symptoms) to 10 (severe symptoms), and the total score is calculated by summing all items. Total scores range from 0 to 60, with higher values indicating more severe AF-related symptoms. After receiving initial instructions, patients completed the questionnaire independently, without interaction from physicians or nurses, and prior to electrocardiogram recording to document actual cardiac rhythm. The Cronbach’s alpha for this study was 0.912, indicating high reliability. Demographic and Clinical Characteristics To describe the sample and account for potential confounding variables, the following information was collected through patient interviews and chart reviews: age, gender, highest education level attained, BMI, and marital status. Clinical characteristics collected through chart reviews included disease duration (years) and New York Heart Association (NYHA) classification. Data on comorbidities and type of AF were also collected through chart reviews. Sample Size Calculation In this study, based on the principle of multivariate analysis, literature review, and group discussion, the number of independent variables included in the equations was set at 10–15. Using a test power of β = 0.8 and a significance level of α = 0.05, the calculated sample size was 117–138. After 12 months of follow-up, a total of 197 patients were included in the study. Procedure Institutional Review Board (IRB) approval was obtained for each site, and all patients provided written informed consent. Research team members were trained, conducted the survey using standardized instructions, explained its purpose, and obtained and documented patients’ informed consent. General demographic data were extracted from patients’ medical records, while PROs were assessed through face-to-face questionnaires. For patients with low educational levels or limited vision, investigators read the questions aloud with clear explanations, providing assistance without offering any suggestions. Questionnaires were distributed and collected on-site, and investigators promptly addressed any missing items. Follow-Up The follow-up period lasted 12 months. Starting from the discharge date, patients or their family members were contacted every two months via WeChat or telephone to assess the patient’s general condition and inquire about any readmission. If a readmission occurred, the name and time of the event were recorded, and MACE and CEFS data were obtained by reviewing medical records to ensure data accuracy. Quality Control The inclusion and exclusion criteria were strictly adhered to. Medical records were reviewed, and responsible doctors and nurses were consulted. Surveys were conducted in a quiet environment, with investigators guiding survey forms and interviewing family members to ensure survey completion and assist with evaluations and documentation. More than two contact details for patients and their family members were retained to reduce the likelihood of missed follow-ups. Data were checked and recorded in duplicate to ensure accuracy. Data Analysis Data were analyzed using SPSS version 18.0, with a p-value of less than 0.05 considered statistically significant. Patients were categorized into groups with better or worse PROs based on the median AF score in this sample. The median score was chosen for this study due to the lack of standard cutpoints and its frequent use as a cutpoint in the literature [ 20 , 21 ]. Differences in demographic and clinical variables between groups defined by median AF scores were assessed using independent t-tests or chi-square tests, depending on the level of measurement. Logistic and linear regressions, t-tests, Pearson correlation analyses, Kaplan-Meier plots with log-rank tests, and Cox regressions were employed to explore the correlation between PROs and cardiac event-free survival. RESULTS Baseline Patient Characteristics A total of 197 patients with complete data on AF6 and cardiac events were included in this study. There were no significant differences in baseline characteristics between these 197 patients and those with incomplete data. The mean age of patients in the sample was 74 ± 9 years, with approximately fifteen percent of patients being male. The majority of patients were married and had primary or lower levels of education. More than half of the patients were classified as NYHA Class III (Table 1 ). Table 1 Baseline Patient Characteristics Characteristics N(%) Age, y (Mean ± SD) 74.056 ± 8.98 Gender Man 91(46.19%) Woman 106(53.81%) BMI,kg/m(mean ± SD) 25.01 ± 4.47 Marital Status Married 160(81.22%) Never married or Window or Divorce or Separate 37(18.78%) Educational Level Primary and Below 139(70.56%) Junior Secondary 41(20.81%) Senior High School and Above 17(8.63%) Type of AF Paroxymal 44(22.34%) Persistent 54(27.41%) Permanent 6(3.05%) Long Range Persistent 93(47.21%) Course of Disease (yr) <3 year 120(60.91%) ≥ 3 year 77(39.09%) Antithrombotic Agents None 73(37.06%) Warfarin 11(5.58%) New Anticoagulant Drugs 113(57.36%) Radio Frequency Ablation Yes 8(4.06%) No 189(90.94%) Comorbidities with Hypertension Yes 109(55.33%) No 88(44.67%) Comorbidities with Coronary Heart Failure Yes 115(58.38%) No 82(41.62%) Comorbidities with Heart Failure Yes 129(65.48%) No 68(34.52%) LVEF <40% 10(5.08%) 40%-49% 24(12.18%) ≥ 50% 163(82.74%) CHA2 DS2 -VASC Score 0 2(1.02%) 1 7(3.55%) 2–9 188(95.43%) New York Heart Association (NYHA) Class(n, %) I 6(3.45%) II 59(29.95%) III 132(67.01%) PROs score <24 109(55.33%) ≥ 24 88(44.67%) Patient-Reported Outcomes in AF Patients in This Population The average AF6 score among the 197 patients was (24.29 ± 8.33). Symptom prevalence rates were 54.0%, 64.0%, 70.0%, 73.1%, 76.7% and 81.2%, respectively. Anxiety due to atrial fibrillation was reported as the most severe symptom, with a median score of 7 points and a maximum score of 10. Among them, more than 50% of patients rated their discomfort, fatigue and anxiety caused by atrial fibrillation with a score of 5 or higher (Table 2 ). Table 2 Patient-Reported Outcomes in AF patients in this Population Item P 50 (P 25 -P 75 )/ ±S Breathing Diffificulties at Rest 1(0,3) Breathing Diffificulties upon Exertion 3(2,7) Limitations in day-to-day Life due to AF 2(3,5) Feeling of Discomfort due to AF 5(2,8) Tiredness due to AF 6(3,8) Worry/Anxiety due to AF 7(4,8) Total Score 24.29 ± 8.33 Association of Patient-Reported Outcomes with Cardiac functional Grading In this study, Spearman correlation analysis was performed to evaluate the relationship between AF PROs and cardiac function grade. The analysis confirmed a monotonic relationship between the two variables. The results indicated a significant positive correlation between cardiac function grade and PROs (rs = 0.360, P < 0.001) (Table 3 ). Table 3 Correlation between AF PROs and cardiac function grade Cardiac Function Grade Item Spearman Grade Correlation Coefficient P Breathing Diffificulties at Rest 0.316 0.001 ** Breathing Diffificulties upon Exertion 0.334 <0.001 ** Limitations in day-to-day Life due to AF 0.280 0.003 ** Feeling of Discomfort due to AF 0.254 0.006 ** Tiredness due to AF 0.452 <0.001 ** Worry/Anxiety due to AF 0.433 <0.001 ** Total Score 0.360 <0.001 ** * P<0.05, ** P<0.01 Association of Patient-Reported Outcomes with Cardiac Event -Free Survival During the follow-up period, 81 cardiac events were recorded including 2 cardiac deaths and 79 cardiac hospitalizations. Among these, 47 events occurred in patients with PROs ≥ 24, while 34 events occurred in those whoes PROs < 24. Kaplan-Meier plots and log-rank tests demonstrated significantly worse cardiac event-free survival in patients with PROs ≥ 24 (P = 0.043; Fig. 1 ). The 12-month follow-up analysis indicated several risk factors for major adverse cardiac events (MACE). Older age (HR = 1.044, P = 0.002), a disease duration of ≥ 3 years (HR = 5.723, P = 0.001), combined heart failure (HR = 1.828, P = 0.015), cardiac function grade III (HR = 1.828, P = 0.015), and PROs ≥ 24 (HR = 1.535, P = 0.05) were associated with an increased risk of MACE, suggesting a higher likelihood of shortened CEFS, as detailed in Table 4 . Table 4 Cox Regression: Major Adverse Cardiovascular Events in Patients with atrial fibrillation within 12 Months of Discharge(n = 197) Characteristics B p HR 95%CI Age, y (Mean ± SD) 0.043 0.002 1.044 1.016–1.072 Gender(vs.Man) Woman 0.132 0.552 1.414 0.739–1.761 BMI,kg/m(mean ± SD) -0.030 0.263 0.970 0.920–1.023 Marital Status(vs.Married) Never Married or Window or Divorce or Separate -0.456 0.282 0.634 0.276–1.455 Educational Level(vs.Primary and Below) 0.147 0.790 1.158 0.391–7.865 Junior Secondary 0.787 0.150 2.197 1.000-1.829 Senior High School and Above 0.304 0.568 1.355 0.454–4.042 Type of AF(vs.Paroxymal) Persistent -0.345 0.223 0.708 0.407–1.234 Permanent -0.489 0.078 0.613 0356-1.056 Long Range Persistent -0.993 0.326 0.370 0.051–2.687 Course of Disease (yr) (vs.<3 year) ≥ 3 year 1.745 0.001 5.723 3.579–9.151 Antithrombotic Agents(vs. none) Warfarin 0.155 0.498 1.168 0.745–1.831 New Anticoagulant Drugs -0.141 0.786 0.868 0.313–2.410 Comorbidities with Hypertension(vs. yes) No 0.2126 0.335 1.242 0.800-1.927 Comorbidities with Coronary Heart Disease(vs. yes) No 0.354 0.124 1.425 0.907–2.239 Comorbidities with Heart Failure(vs. yes) No 0.603 0.015 1.828 1.122–2.978 LVEF(vs. <40%) 40%-49% -0.601 0.264 0.548 0.191–1.575 ≥ 50% -0.662 0176 0.516 0.197–1.347 CHA2 DS2 -VASC score(vs. 0) 1 -1.065 0.963 0.056 0.045–1.145 2–9 -1.298 0.197 0.273 0.038–1.961 NYHA(%)(vs. I) II -1.438 0.154 0.237 0.033–1.712 III -0.803 0.003 0.448 0.262–0.765 PROs Score(vs. <24) ≥ 24 0.429 0.050 1.535 0.996–2.366 The relationship between PROs and the occurrence of MACE over 12 months of follow-up was further analyzed using a COX multivariate survival analysis model. Two models were constructed to identify variables associated with MACE risk (P < 0.1): Model 1 was adjusted for age and Model 2 was adjusted for AF type, disease duration, combined heart failure and cardiac function grade, based on Model 1. The analysis showed that during the 12 months of follow-up, PROs, age, disease duration, and combined heart failure were independent predictors of MACE. Specifically PROs ≥ 24 points, older age, a disease of ≥ 3 years, and combined heart failure significantly increased risk of MACE, further suggesting the possibility of a shortened CEFS, as detailed in Table 5 . Table 5 Cox Regression: Patient-Reported Outcomes on Major Adverse Cardiovascular Events in Patients with atrial fibrillation Variable Model 1 Model 2 HR 95% CI P HR 95% CI P PROs Score(vs. <24) 4.442 2.584–7.633 0.001 1.794 1.153–2.790 0.010 Age, y (mean ± SD) 1.041 1.006–1.076 0.021 1.051 1.022–1.082 0.001 Type of AF(vs.Paroxymal) Persistent - - - 0.256 0.225 − 0.154 0.239 Permanent - - - 1.176 0.668–2.071 0.573 Long Range Persistent - - - 0.286 0.039–2.099 0.218 Course of Disease (yr) (vs.<3 year) 0.154 0.091–0.261 0.001 ≥ 3 year - - - Comorbidities with Heart Failure(vs. yes) - - - 4.262 1.724–10.539 0.002 ** NYHA(%)(vs. I) II - - - 1.176 0.668–2.071 0.573 III - - - 1.256 0.225–2.154 0.689 DISCUSSION Current status of AF PROs and their consistency with cardiac functional grading In this study, the AF specific questionnaire was assessed using AF6 scale. As a symptom classification tool with fewer items and simple scores, the AF6 scale demonstrated good consistency with cardiac function classification. Scores for 6 individual items and the total AF6 score were positively correlated with cardiac function grade. This indicated that higher AF6 scores correspond to a higher cardiac function grade and the worse PROs. Consistent with the results of this study, Anna et al reported that the AF6 scale was more sensitive to changes in AF symptom burden compared to the SF-36 scale [ 18 ]. In 2017, the team further evaluated AF6 symptoms using the AF6 scale and found that the symptoms improved over 6 months. Both AF6 score and cardiac function grades were significantly associated with AF burden [ 19 ]. These findings support the use of AF6 scale as a reliable tool for evaluating AF specific PROs. In this study, the individual item scores on the AF6 scale were 54%, 63.96%, 69.696%, 73.10%, 76.65% and 81.22%, respectively. Anxiety due to atrial fibrillation was identified as the most severe symptom, with a median score of 7 and a maximum of 10. Additional, more than 50% of patients reported significant discomfort, fatigue and anxiety caused by atrial fibrillation. This indicates that all 197 patients included in the study experienced varying degrees of symptom burden, with PROs reflecting a moderate symptom level overall. The concept of PROs originated in the 1960s but gained focus in the context of atrial fibrillation only in recent decades[ 22 ]. The traditional medical approaches have primarily emphasized objective indicators such as the frequency of atrial fibrillation and the incidence of stroke. Incorporating PROs into clinical pathways for patients with atrial fibrillation alongside traditional anatomical, biological, and clinical data, could enhance clinicians’ awareness of symptoms, improve symptom management, and contribute to better cardiac function outcomes[ 23 ]. Age and course of disease were independent risk factors for reduced event-free survival time in one year in patients with AF This study found that age and disease duration were independent risk factors for reduced event-free survival time within one year. Specifically, older patients and those with a longer disease duration experienced shorter event-free survival times. This may be attributed to the high prevalence of chronic diseases among elderly patients with atrial fibrillation (AF). With the gradual establishment of the medical insurance system in China, the role of community health service centers in facilitating hierarchical diagnosis and treatment has not been fully realized. Consequently, the hospitalization demand for elderly patients with AF continues to increase year by year. Consistent with the findings of this study, one survey reported that the hospitalization rate of Chinese residents increased between 2003 and 2018, with residents aged 65 years and older having the highest rates[ 24 ]. Additionally, data from the Chinese Atrial Fibrillation Registration study (CHINA-AF)[ 25 ] showed that among 23,108 patients with AF, more than one-third experienced one or more hospitalizations during an average follow-up of over three years. These findings highlight the importance of comprehensive management of complications in elderly patients with AF and a long disease duration. Furthermore, relevant institutions should implement appropriate measures to establish a more efficient hierarchical diagnosis and treatment system. This would help reduce the economic burden of medical care for both patients and society as a whole. Predictive Effect of PROs on Reduced Event-Free Survival Time in One Year Among Patients with AF Shortened event-free survival time corresponds to an increase in hospitalizations, which can serve as a surrogate marker for the economic burden associated with patient morbidity and healthcare expenditure[ 26 – 27 ]. Among the 197 patients included in this study, 81 (41.12%) were hospitalized twice within one year. Similarly, previous studies have reported that approximately 31% of patients with AF required one or more hospitalizations annually[ 28 – 29 ]. The factors influencing event-free survival time in patients with AF are multifaceted, encompassing both established cardiovascular risk factors and other variables. However, there are relatively few studies investigating the impact of PROs on event-free survival time in AF patients within one year. In this study, univariate analysis revealed that age, disease duration, comorbidity with heart failure, and cardiac function grade were all associated with an increased likelihood of rehospitalization in AF patients within one year. To further explore these relationships, a multivariate COX proportional hazards model was developed, incorporating variables such as age, disease duration, heart failure comorbidity, and cardiac function grade. The analysis demonstrated that patients with a total PROs score ≥ 24 had a significantly higher risk of reduced event-free survival time compared to those with a score < 24. These findings suggest that poor PROs in AF patients may contribute to shortened event-free survival time. Interventions targeting PROs could play a crucial role in improving patient outcomes and extending event-free survival time. This highlights the importance of incorporating PRO-oriented strategies into clinical management for patients with AF. CONCLUSION The evaluation of AF PROs serves as a foundation for the effective management of patients with atrial fibrillation. This study found that AF PROs were at a moderate level overall, with anxiety being the most severe symptom reported by patients. The PROs were strongly aligned with cardiac function classification, further validating their clinical relevance. The findings highlight the need to prioritize event-free survival time in elderly AF patients with long disease duration, as these patients are at greater risk of hospitalization. Additionally, poor PROs were associated with a higher likelihood of reduced event-free survival time, underscoring the importance of addressing patient-reported outcomes in clinical care. As one of the early studies to explore the relationship between AF PROs and hospitalization rates in China, this research provides a meaningful direction for improving the management of AF patients. By integrating PROs into patient evaluation and management, healthcare providers can develop targeted interventions to enhance patient outcomes and reduce hospitalization rates. Limitations This study is a single-center small sample survey; without further exploring the factors affecting heart rate control, patient compliance and other rehospitalization times of AF. Declarations AUTHOR CONTRIBUTIONS All authors listed have made a substantial, direct and intellectual contribution to the work, and approved it for publication. Author contributions: Dong Zhifeng contributed to the conception of the study; Hui Sun performed the experiment; Chenglin Zhang, Lu Cai contributed significantly to analysis and manuscript preparation; Hui Sun , Xuemei Li performed the data analyses and wrote the manuscript; Chenglin Zhang,,Xiaoyan Li helped perform the analysis with constructive discussions. Funding: This study did not receive funding from external or internal sources. Disclosures: The authors have no conflicts of interest to disclose. Acknowledgement: The authors wish to thank six hospitals for their support, and acknowledge all participants with AF who assisted with the study. Data availability: The datasets generated and analyzed during the current study are not publicly available due to the protection of the privacy of the subjects under investigation but are available from the corresponding author ( [email protected] )on reasonable request. Ethics approval and consent to participate : The study protocol was approved by the ethics committee of the Yancheng School of Clinical Medicine, Nanjing Medical University by the Declaration of Helsinki(No.2023-84). All methods were performed according to relevant guidelines and regulations. Informed consent was obtained from all the participants and/or legal guardians for the study. Consent for publication : Not Applicable. References Brundel BJJM, Ai X, Hills MT, Kuipers MF, Lip GYH, de Groot NMS. Atrial fibrillation. Nat Rev Dis Primers. 2022;8(1):21. 10.1038/s41572-022-00347-9 . Published 2022 Apr 7. Kotalczyk A, Lip GY, Calkins H. The 2020 ESC Guidelines on the Diagnosis and Management of Atrial Fibrillation. Arrhythm Electrophysiol Rev. 2021;10(2):65–7. 10.15420/aer.2021.07 . Hendriks JM, Gallagher C, Middeldorp ME, Lau DH, Sanders P. Risk factor management and atrial fibrillation. Europace. 2021;23(23 Suppl 2):ii52–60. 10.1093/europace/euaa346 . Sale A, Yu J. Quality of life instruments in atrial fibrillation: a systematic review of measurement properties. Health Qual Life Outcomes. 2022;20(1):143. 10.1186/s12955-022-02057-y . Published 2022 Oct 17. Cai M, Hua W, Zhang N et al. A prognostic nomogram for event-free survival in patients with atrial fibrillation before cardiac resynchronization therapy. BMC Cardiovasc Disord. 2020;20(1):221. Published 2020 May 13. 10.1186/s12872-020-01502-4 Tao S, Yu L, Li J, et al. Association between the triglyceride-glucose index and 1-year major adverse cardiovascular events in patients with coronary heart disease and hypertension. Cardiovasc Diabetol. 2023;22(1):305. 10.1186/s12933-023-02018-9 . Published 2023 Nov 8. Humphries B, Cox JL, Parkash R, et al. Patient-Reported Outcomes and Patient-Reported Experience of Patients With Atrial Fibrillation in the IMPACT-AF Clinical Trial. J Am Heart Assoc. 2021;10(15):e019783. 10.1161/JAHA.120.019783 . Chen Y, Tertulien T, Althouse AD, Johnson A, Gisi B, Magnani JW. Association of patient-reported outcomes with hospitalization risk in atrial fibrillation. Am Heart J Plus. 2021;2:100007. 10.1016/j.ahjo.2021.100007 . Kolk MZH, Blok S, De Wildt MCC, et al. Patient-reported outcomes in symptom-driven remote arrhythmia monitoring: evaluation of the Dutch HartWacht-telemonitoring programme. Eur Heart J Digit Health. 2021;2(2):224–30. 10.1093/ehjdh/ztab030 . Published 2021 Mar 9. Steinberg BA, Dorian P, Anstrom KJ, et al. Patient-Reported Outcomes in Atrial Fibrillation Research: Results of a Clinicaltrials.gov Analysis. JACC Clin Electrophysiol. 2019;5(5):599–605. 10.1016/j.jacep.2019.03.008 . Steinberg BA, Woolley S, Li H, et al. Patient-reported outcomes and costs associated with vascular closure and same-day discharge following atrial fibrillation ablation. J Cardiovasc Electrophysiol. 2022;33(8):1737–44. 10.1111/jce.15555 . Steinberg BA, Piccini JPS. Tackling Patient-Reported Outcomes in Atrial Fibrillation and Heart Failure: Identifying Disease-Specific Symptoms? Cardiol Clin. 2019;37(2):139–46. 10.1016/j.ccl.2019.01.013 . Lorusso D, Mouret-Reynier MA, Harter P, et al. Updated progression-free survival and final overall survival with maintenance olaparib plus bevacizumab according to clinical risk in patients with newly diagnosed advanced ovarian cancer in the phase III PAOLA-1/ENGOT-ov25 trial. Int J Gynecol Cancer. 2024;34(4):550–8. 10.1136/ijgc-2023-004995 . Published 2024 Apr 1. González-Martín A, Pothuri B, Vergote I, et al. Progression-free survival and safety at 3.5years of follow-up: results from the randomised phase 3 PRIMA/ENGOT-OV26/GOG-3012 trial of niraparib maintenance treatment in patients with newly diagnosed ovarian cancer. Eur J Cancer. 2023;189:112908. 10.1016/j.ejca.2023.04.024 . Neuen BL, Heerspink HJL, Vart P, et al. Estimated Lifetime Cardiovascular, Kidney, and Mortality Benefits of Combination Treatment With SGLT2 Inhibitors, GLP-1 Receptor Agonists, and Nonsteroidal MRA Compared With Conventional Care in Patients With Type 2 Diabetes and Albuminuria. Circulation. 2024;149(6):450–62. 10.1161/CIRCULATIONAHA.123.067584 . Verdonschot JAJ, Hazebroek MR, Krapels IPC, et al. Implications of Genetic Testing in Dilated Cardiomyopathy. Circ Genom Precis Med. 2020;13(5):476–87. 10.1161/CIRCGEN.120.003031 . Georgiopoulos G, Makris N, Laina A, et al. Cardiovascular Toxicity of Proteasome Inhibitors: Underlying Mechanisms and Management Strategies: JACC: CardioOncology State-of-the-Art Review. JACC CardioOncol. 2023;5(1):1–21. 10.1016/j.jaccao.2022.12.005 . Published 2023 Feb 21. Härdén M, Nyström B, Kulich K, Carlsson J, Bengtson A, Edvardsson N. Validity and reliability of a new, short symptom rating scale in patients with persistent atrial fibrillation. Health Qual Life Outcomes. 2009;7:65. Published 2009 Jul 15. 10.1186/1477-7525-7-65 Härdén M, Nyström B, Bengtson A, Medin J, Frison L, Edvardsson N. Responsiveness of AF6, a new, short, validated, atrial fibrillation-specific questionnaire–symptomatic benefit of direct current cardioversion. J Interv Card Electrophysiol. 2010;28(3):185–91. 10.1007/s10840-010-9487-3 . Wu JR, Lennie TA, Frazier SK, Moser DK. Health-Related Quality of Life, Functional Status, and Cardiac Event-Free Survival in Patients With Heart Failure. J Cardiovasc Nurs. 2016;31(3):236–44. 10.1097/JCN.0000000000000248 . Wu JR, Moser DK. Health-Related Quality of Life Is a Mediator of the Relationship Between Medication Adherence and Cardiac Event-Free Survival in Patients with Heart Failure. J Card Fail. 2021;27(8):848–56. 10.1016/j.cardfail.2021.03.004 . Kwon JY, Sawatzky R, Baumbusch J, Ratner PA. Patient-reported outcomes and the identification of subgroups of atrial fibrillation patients: a retrospective cohort study of linked clinical registry and administrative data. Qual Life Res. 2021;30(6):1547–59. 10.1007/s11136-021-02777-6 . Kotronoulas G, Kearney N, Maguire R, et al. What is the value of the routine use of patient-reported outcome measures toward improvement of patient outcomes, processes of care, and health service outcomes in cancer care? A systematic review of controlled trials. J Clin Oncol. 2014;32(14):1480–501. 10.1200/JCO.2013.53.5948 . Gu H, Huang J, Qiao S, Chen X, Cao X. Predictors of participation in atrial fibrillation screening among community residents in China. Heart Lung. 2023;61:59–64. 10.1016/j.hrtlng.2023.04.015 . Dong Z, Du X, Lu S et al. Incidence and predictors of hospitalization in patients with atrial fibrillation: results from the Chinese atrial fibrillation registry study. BMC Cardiovasc Disord. 2021;21(1):146. Published 2021 Mar 19. 10.1186/s12872-021-01951-5 Douglas-de-Oliveira DW, Chen KJ. Patient-reported measures outcomes: modern evaluation of oral health. BMC Oral Health. 2023;23(1):498. 10.1186/s12903-023-03219-0 . Published 2023 Jul 18. Irvine I, Hayden R, Greene L, Ryan AG. An Update on Patient-Reported Outcomes in Interventional Radiology: The Future Measure of Our Success. Cardiovasc Intervent Radiol. 2023;46(12):1657–61. 10.1007/s00270-023-03530-x . Rozen G, Hosseini SM, Kaadan MI et al. Emergency Department Visits for Atrial Fibrillation in the United States: Trends in Admission Rates and Economic Burden From 2007 to 2014. J Am Heart Assoc. 2018;7(15):e009024. Published 2018 Jul 20. 10.1161/JAHA.118.009024 Schak L, Petersen JK, Vinding NE, et al. Temporal changes in incidence, treatment strategies and 1-year re-admission rates in patients with atrial fibrillation/flutter under 65 years of age: A Danish nationwide study. Int J Cardiol. 2023;382:23–32. 10.1016/j.ijcard.2023.04.007 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 30 Apr, 2026 Reviews received at journal 03 Jun, 2025 Reviewers agreed at journal 29 May, 2025 Reviewers invited by journal 14 May, 2025 Editor assigned by journal 13 May, 2025 Editor invited by journal 21 Apr, 2025 Submission checks completed at journal 19 Apr, 2025 First submitted to journal 19 Apr, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6415932","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":457745630,"identity":"bab23f9b-9578-48d1-8e37-c869426e6ca2","order_by":0,"name":"Chenglin Zhang","email":"","orcid":"","institution":"Nanjing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Chenglin","middleName":"","lastName":"Zhang","suffix":""},{"id":457745631,"identity":"7565b6e3-7ce2-4662-a5fb-30ac08dc3850","order_by":1,"name":"Lu Cai","email":"","orcid":"","institution":"Nanjing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Lu","middleName":"","lastName":"Cai","suffix":""},{"id":457745632,"identity":"92e37c8a-7850-44ee-97dc-0639298bf7ed","order_by":2,"name":"Hui Sun","email":"","orcid":"","institution":"Nanjing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Hui","middleName":"","lastName":"Sun","suffix":""},{"id":457745633,"identity":"792f3ad0-2f21-43e5-b750-bba6a6c20d4f","order_by":3,"name":"Xuemei Li","email":"","orcid":"","institution":"Nanjing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Xuemei","middleName":"","lastName":"Li","suffix":""},{"id":457745634,"identity":"e17d0398-7a9a-4f83-abda-0e84d117732d","order_by":4,"name":"Xiaoyan Li","email":"","orcid":"","institution":"Nanjing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Xiaoyan","middleName":"","lastName":"Li","suffix":""},{"id":457745635,"identity":"acff3319-e543-49eb-b4ba-b80bd68ad2ba","order_by":5,"name":"Zhifeng Dong","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8klEQVRIiWNgGAWjYDACCcaGD0CKsQGIH3wwsJEjRkvjDKgWZsMZBWnGRGhhYIRpYRPm+XA4kaAO+dnNjQ0fd9TK9ku3X2O2MWBOYGA/fHQDPi2Mcw42Ns48c9x45pwzZY9zDNjyGHjS0m7g08Iskdj+mLftWOKGGznpxjkGPMUMEjxmeLWwSSQ2Nv+FaEmTtjCQSGwgpIUHpIWxrQaoJf2YNIOBAWEtEkAtjb1tB4xnzshhNuwxSDBmI+QX+RnpDxt+ttXJ9kukP3zw489/OX72w8fwaoGCwyA3GkB8R4RyEKgDYvYHRCoeBaNgFIyCkQYAdoJRdAL3uWAAAAAASUVORK5CYII=","orcid":"","institution":"Nanjing Medical University","correspondingAuthor":true,"prefix":"","firstName":"Zhifeng","middleName":"","lastName":"Dong","suffix":""}],"badges":[],"createdAt":"2025-04-10 03:23:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6415932/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6415932/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":83108039,"identity":"2bcf3933-10b1-49ba-84a8-42da60065f2f","added_by":"auto","created_at":"2025-05-20 06:45:47","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":75687,"visible":true,"origin":"","legend":"\u003cp\u003eFlow Diagram of Screening Research Subjects\u003c/p\u003e","description":"","filename":"Picture1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6415932/v1/3902fc36b3fc62be2fa6056e.jpg"},{"id":83108040,"identity":"28582641-d188-4100-bef2-3a50c3c4ee62","added_by":"auto","created_at":"2025-05-20 06:45:47","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":15792,"visible":true,"origin":"","legend":"\u003cp\u003eKaplan-Meier Plots : Patient-Reported Outcomes and Cardiac Event-free Survival Time\u003c/p\u003e","description":"","filename":"Picture2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6415932/v1/e880c649cfca939d2ae52c63.jpg"},{"id":83110402,"identity":"d66f52cb-012f-4181-951d-79dd43b6a5a6","added_by":"auto","created_at":"2025-05-20 07:09:47","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1190855,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6415932/v1/cc9a4ed3-f85e-4ed2-bf3e-ce5365d674e5.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Correlating Patient-Reported Outcomes and Cardiac Event-Free Survival Time in Patients with Atrial Fibrillation: A Prospective Study","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eAtrial fibrillation (AF) is one of the most common persistent arrhythmias, which is also an important cause of morbidity and mortality from cardiovascular disease [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. According to the 2020 ESC Guidelines for Diagnosis and Management of Atrial Fibrillation, the prevalence of AF is estimated at 2\u0026ndash;4% [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. While AF is not directly life-threatening, recurrent symptoms and associated adverse cardiovascular events significantly reduce cardiac event-free survival (CEFS), bringing a huge burden on patients, families and the entire medical resources[\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. CEFS refers to the duration of re-hospitalization or death from stable discharge to the next major adverse cardiovascular event (MACE) [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], while MACE encompasses acute left heart failure, cardiogenic shock, malignant arrhythmia, recurrent angina, AS syndrome and death.\u003c/p\u003e \u003cp\u003eBeyond anticoagulation therapy for stroke prevention, increasing attention has been given to the significance of patient-reported outcomes (PROs) in patients with AF [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. PROs originated in the 1960s, but studies focusing on PROs in AF only began in this century [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. PROs encompass health information, functional levels, and health-related quality of life (HRQoL) [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. PROs refer to reports of health status provided directly by patients, without interpretation by healthcare staff or others, emphasizing a patient-centered approach. Numerous regional studies have indicated that PROs play an important role in symptom management, clinical decision-making, and\u003c/p\u003e \u003cp\u003eevaluating treatment effectiveness in patients with breast cancer, pancreatic cancer, and chronic obstructive pulmonary disease[\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. This study aims to investigate the current status of PROs in AF and to explore their correlation with CEFS.We examined whether the relationship between PROs and CEFS could provide evidence to guide strategies for improving PROs and extending CEFS in patients with AF.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design and Participants\u003c/h2\u003e \u003cp\u003eThis prospective, observational study was a secondary analysis involving 197 patients recruited from the inpatient department of a tertiary hospital in China. Patients were eligible for inclusion if they had a confirmed diagnosis of AF, clear awareness, normal communication abilities, and provided informed consent. Patients were excluded if they had cardiac function grade IV, were pregnant or lactating, had malignant diseases (e.g., malignant tumors or hematological disorders), or had severe psychiatric or cognitive impairment unrelated to depression or anxiety. For this study, only patients with complete data on PROs and cardiac events were included. The study received approval from the local Institutional Review Board (IRB).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eMeasurement\u003c/h3\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eCardiac Event-Free Survival\u003c/h2\u003e \u003cp\u003eCardiac event-free survival was defined as the composite endpoint representing the time to the first occurrence of one of the following cardiac events from the enrollment date: cardiac emergency department (ED) visits, cardiac hospitalizations, or cardiac mortality. This composite end-point is commonly used in similar research [\u003cspan additionalcitationids=\"CR14 CR15 CR16\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. During data collection, the dates and reasons for hospitalization and deaths were noted. Data were collected by trained research assistants with expertise in cardiovascular nursing through patient or family interviews and hospital database records.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ePatient-Reported Outcomes\u003c/h3\u003e\n\u003cp\u003eSymptoms were assessed using the AF-Specific Questionnaire 6 (AF6), a tool that has undergone thorough validation [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] and clinical responsiveness testing [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], with a recall period of the past 7 days. The 6-item questionnaire assesses patient-reported AF-related symptoms: (1) \u0026ldquo;breathing difficulties at rest\u0026rdquo;; (2) \u0026ldquo;breathing difficulties upon exertion\u0026rdquo;; (3) \u0026ldquo;limitations in day-to-day life due to AF\u0026rdquo;; (4) \u0026ldquo;feeling of discomfort due to AF\u0026rdquo;; (5) \u0026ldquo;tiredness due to AF\u0026rdquo;; and (6) \u0026ldquo;worry/anxiety due to AF.\u0026rdquo; Each item is scored from 0 (no symptoms) to 10 (severe symptoms), and the total score is calculated by summing all items. Total scores range from 0 to 60, with higher values indicating more severe AF-related symptoms. After receiving initial instructions, patients completed the questionnaire independently, without interaction from physicians or nurses, and prior to electrocardiogram recording to document actual cardiac rhythm. The Cronbach\u0026rsquo;s alpha for this study was 0.912, indicating high reliability.\u003c/p\u003e\n\u003ch3\u003eDemographic and Clinical Characteristics\u003c/h3\u003e\n\u003cp\u003eTo describe the sample and account for potential confounding variables, the following information was collected through patient interviews and chart reviews: age, gender, highest education level attained, BMI, and marital status. Clinical characteristics collected through chart reviews included disease duration (years) and New York Heart Association (NYHA) classification. Data on comorbidities and type of AF were also collected through chart reviews.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eSample Size Calculation\u003c/h2\u003e \u003cp\u003eIn this study, based on the principle of multivariate analysis, literature review, and group discussion, the number of independent variables included in the equations was set at 10\u0026ndash;15. Using a test power of β\u0026thinsp;=\u0026thinsp;0.8 and a significance level of α\u0026thinsp;=\u0026thinsp;0.05, the calculated sample size was 117\u0026ndash;138. After 12 months of follow-up, a total of 197 patients were included in the study.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eProcedure\u003c/h3\u003e\n\u003cp\u003eInstitutional Review Board (IRB) approval was obtained for each site, and all patients provided written informed consent. Research team members were trained, conducted the survey using standardized instructions, explained its purpose, and obtained and documented patients\u0026rsquo; informed consent. General demographic data were extracted from patients\u0026rsquo; medical records, while PROs were assessed through face-to-face questionnaires. For patients with low educational levels or limited vision, investigators read the questions aloud with clear explanations, providing assistance without offering any suggestions. Questionnaires were distributed and collected on-site, and investigators promptly addressed any missing items.\u003c/p\u003e\n\u003ch3\u003eFollow-Up\u003c/h3\u003e\n\u003cp\u003eThe follow-up period lasted 12 months. Starting from the discharge date, patients or their family members were contacted every two months via WeChat or telephone to assess the patient\u0026rsquo;s general condition and inquire about any readmission. If a readmission occurred, the name and time of the event were recorded, and MACE and CEFS data were obtained by reviewing medical records to ensure data accuracy.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eQuality Control\u003c/h2\u003e \u003cp\u003eThe inclusion and exclusion criteria were strictly adhered to. Medical records were reviewed, and responsible doctors and nurses were consulted. Surveys were conducted in a quiet environment, with investigators guiding survey forms and interviewing family members to ensure survey completion and assist with evaluations and documentation. More than two contact details for patients and their family members were retained to reduce the likelihood of missed follow-ups. Data were checked and recorded in duplicate to ensure accuracy.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eData were analyzed using SPSS version 18.0, with a p-value of less than 0.05 considered statistically significant. Patients were categorized into groups with better or worse PROs based on the median AF score in this sample. The median score was chosen for this study due to the lack of standard cutpoints and its frequent use as a cutpoint in the literature [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Differences in demographic and clinical variables between groups defined by median AF scores were assessed using independent t-tests or chi-square tests, depending on the level of measurement. Logistic and linear regressions, t-tests, Pearson correlation analyses, Kaplan-Meier plots with log-rank tests, and Cox regressions were employed to explore the correlation between PROs and cardiac event-free survival.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eBaseline Patient Characteristics\u003c/h2\u003e \u003cp\u003eA total of 197 patients with complete data on AF6 and cardiac events were included in this study. There were no significant differences in baseline characteristics between these 197 patients and those with incomplete data. The mean age of patients in the sample was 74\u0026thinsp;\u0026plusmn;\u0026thinsp;9 years, with approximately fifteen percent of patients being male. The majority of patients were married and had primary or lower levels of education. More than half of the patients were classified as NYHA Class III (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline Patient Characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN(%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, y (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e74.056\u0026thinsp;\u0026plusmn;\u0026thinsp;8.98\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e91(46.19%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWoman\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e106(53.81%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI,kg/m(mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25.01\u0026thinsp;\u0026plusmn;\u0026thinsp;4.47\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital Status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e160(81.22%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever married or Window or Divorce or Separate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37(18.78%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducational Level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary and Below\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e139(70.56%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJunior Secondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41(20.81%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSenior High School and Above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17(8.63%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType of AF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParoxymal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44(22.34%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePersistent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54(27.41%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePermanent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6(3.05%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLong Range Persistent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e93(47.21%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCourse of Disease (yr)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;3 year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e120(60.91%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;3 year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e77(39.09%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAntithrombotic Agents\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e73(37.06%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWarfarin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11(5.58%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNew Anticoagulant Drugs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e113(57.36%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRadio Frequency Ablation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8(4.06%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e189(90.94%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComorbidities with Hypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e109(55.33%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e88(44.67%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComorbidities with Coronary Heart Failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e115(58.38%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e82(41.62%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComorbidities with Heart Failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e129(65.48%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e68(34.52%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLVEF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;40%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10(5.08%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e40%-49%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24(12.18%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;50%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e163(82.74%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCHA2 DS2 -VASC Score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2(1.02%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7(3.55%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u0026ndash;9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e188(95.43%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNew York Heart Association (NYHA) Class(n, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6(3.45%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e59(29.95%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e132(67.01%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePROs score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e109(55.33%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e88(44.67%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003ePatient-Reported Outcomes in AF Patients in This Population\u003c/h2\u003e \u003cp\u003eThe average AF6 score among the 197 patients was (24.29\u0026thinsp;\u0026plusmn;\u0026thinsp;8.33). Symptom prevalence rates were 54.0%, 64.0%, 70.0%, 73.1%, 76.7% and 81.2%, respectively. Anxiety due to atrial fibrillation was reported as the most severe symptom, with a median score of 7 points and a maximum score of 10. Among them, more than 50% of patients rated their discomfort, fatigue and anxiety caused by atrial fibrillation with a score of 5 or higher (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePatient-Reported Outcomes in AF patients in this Population\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003csub\u003e\u003cem\u003e50\u003c/em\u003e\u003c/sub\u003e \u003cem\u003e(P\u003c/em\u003e\u003csub\u003e\u003cem\u003e25\u003c/em\u003e\u003c/sub\u003e\u003cem\u003e-P\u003c/em\u003e\u003csub\u003e\u003cem\u003e75\u003c/em\u003e\u003c/sub\u003e\u003cem\u003e)/\u003c/em\u003e\u003cem\u003e\u0026plusmn;S\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBreathing Diffificulties at Rest\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1(0,3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBreathing Diffificulties upon Exertion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3(2,7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLimitations in day-to-day Life due to AF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2(3,5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFeeling of Discomfort due to AF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5(2,8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTiredness due to AF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6(3,8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWorry/Anxiety due to AF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7(4,8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal Score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24.29\u0026thinsp;\u0026plusmn;\u0026thinsp;8.33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eAssociation of Patient-Reported Outcomes with Cardiac functional Grading\u003c/h2\u003e \u003cp\u003eIn this study, Spearman correlation analysis was performed to evaluate the relationship between AF PROs and cardiac function grade. The analysis confirmed a monotonic relationship between the two variables. The results indicated a significant positive correlation between cardiac function grade and PROs (rs\u0026thinsp;=\u0026thinsp;0.360, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCorrelation between AF PROs and cardiac function grade\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eCardiac Function Grade\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSpearman Grade Correlation Coefficient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBreathing Diffificulties at Rest\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.316\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBreathing Diffificulties upon Exertion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.334\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;0.001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLimitations in day-to-day Life due to AF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.280\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.003\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFeeling of Discomfort due to AF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.254\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.006\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTiredness due to AF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.452\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;0.001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWorry/Anxiety due to AF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.433\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;0.001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal Score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.360\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;0.001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003e\u003csup\u003e*\u003c/sup\u003e P\u0026lt;0.05,\u003csup\u003e**\u003c/sup\u003e P\u0026lt;0.01\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eAssociation of Patient-Reported Outcomes with Cardiac Event -Free Survival\u003c/h2\u003e \u003cp\u003eDuring the follow-up period, 81 cardiac events were recorded including 2 cardiac deaths and 79 cardiac hospitalizations. Among these, 47 events occurred in patients with PROs\u0026thinsp;\u0026ge;\u0026thinsp;24, while 34 events occurred in those whoes PROs \u0026lt; 24. Kaplan-Meier plots and log-rank tests demonstrated significantly worse cardiac event-free survival in patients with PROs\u0026thinsp;\u0026ge;\u0026thinsp;24 (P\u0026thinsp;=\u0026thinsp;0.043; Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The 12-month follow-up analysis indicated several risk factors for major adverse cardiac events (MACE). Older age (HR\u0026thinsp;=\u0026thinsp;1.044, P\u0026thinsp;=\u0026thinsp;0.002), a disease duration of \u0026ge;\u0026thinsp;3 years (HR\u0026thinsp;=\u0026thinsp;5.723, P\u0026thinsp;=\u0026thinsp;0.001), combined heart failure (HR\u0026thinsp;=\u0026thinsp;1.828, P\u0026thinsp;=\u0026thinsp;0.015), cardiac function grade III (HR\u0026thinsp;=\u0026thinsp;1.828, P\u0026thinsp;=\u0026thinsp;0.015), and PROs\u0026thinsp;\u0026ge;\u0026thinsp;24 (HR\u0026thinsp;=\u0026thinsp;1.535, P\u0026thinsp;=\u0026thinsp;0.05) were associated with an increased risk of MACE, suggesting a higher likelihood of shortened CEFS, as detailed in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCox Regression: Major Adverse Cardiovascular Events in Patients with atrial fibrillation within 12 Months of Discharge(n\u0026thinsp;=\u0026thinsp;197)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eB\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eHR\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e95%CI\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, y (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.043\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.044\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.016\u0026ndash;1.072\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender(vs.Man)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWoman\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.132\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.552\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.414\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.739\u0026ndash;1.761\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI,kg/m(mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.030\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.263\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.970\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.920\u0026ndash;1.023\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital Status(vs.Married)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever Married or Window or Divorce or Separate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.456\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.282\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.634\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.276\u0026ndash;1.455\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducational Level(vs.Primary and Below)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.147\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.790\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.158\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.391\u0026ndash;7.865\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJunior Secondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.787\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.150\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.197\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.000-1.829\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSenior High School and Above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.304\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.568\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.355\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.454\u0026ndash;4.042\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType of AF(vs.Paroxymal)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePersistent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.345\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.223\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.708\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.407\u0026ndash;1.234\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePermanent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.489\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.078\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.613\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0356-1.056\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLong Range Persistent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.993\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.326\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.370\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.051\u0026ndash;2.687\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCourse of Disease (yr) (vs.\u0026lt;3 year)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;3 year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.745\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.723\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.579\u0026ndash;9.151\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAntithrombotic Agents(vs. none)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWarfarin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.155\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.498\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.168\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.745\u0026ndash;1.831\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNew Anticoagulant Drugs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.141\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.786\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.868\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.313\u0026ndash;2.410\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComorbidities with Hypertension(vs. yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.2126\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.335\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.242\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.800-1.927\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComorbidities with Coronary Heart Disease(vs. yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.354\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.124\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.425\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.907\u0026ndash;2.239\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComorbidities with Heart Failure(vs. yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.603\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.828\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.122\u0026ndash;2.978\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLVEF(vs. \u0026lt;40%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e40%-49%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.601\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.264\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.548\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.191\u0026ndash;1.575\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;50%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.662\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0176\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.516\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.197\u0026ndash;1.347\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCHA2 DS2 -VASC score(vs. 0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-1.065\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.963\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.056\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.045\u0026ndash;1.145\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u0026ndash;9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-1.298\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.197\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.273\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.038\u0026ndash;1.961\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNYHA(%)(vs. I)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-1.438\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.154\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.237\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.033\u0026ndash;1.712\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.803\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.448\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.262\u0026ndash;0.765\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePROs Score(vs. \u0026lt;24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.429\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.050\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.535\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.996\u0026ndash;2.366\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe relationship between PROs and the occurrence of MACE over 12 months of follow-up was further analyzed using a COX multivariate survival analysis model. Two models were constructed to identify variables associated with MACE risk (P\u0026thinsp;\u0026lt;\u0026thinsp;0.1): Model 1 was adjusted for age and Model 2 was adjusted for AF type, disease duration, combined heart failure and cardiac function grade, based on Model 1. The analysis showed that during the 12 months of follow-up, PROs, age, disease duration, and combined heart failure were independent predictors of MACE. Specifically PROs\u0026thinsp;\u0026ge;\u0026thinsp;24 points, older age, a disease of \u0026ge;\u0026thinsp;3 years, and combined heart failure significantly increased risk of MACE, further suggesting the possibility of a shortened CEFS, as detailed in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCox Regression: Patient-Reported Outcomes on Major Adverse Cardiovascular Events in Patients with atrial fibrillation\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u003cem\u003eModel 1\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003e\u003cem\u003eModel 2\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eHR\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e95% CI\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eHR\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003e95% CI\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePROs Score(vs. \u0026lt;24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.442\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.584\u0026ndash;7.633\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.794\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.153\u0026ndash;2.790\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.010\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, y (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.041\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.006\u0026ndash;1.076\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.051\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.022\u0026ndash;1.082\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType of AF(vs.Paroxymal)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePersistent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.256\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.225\u0026thinsp;\u0026minus;\u0026thinsp;0.154\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.239\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePermanent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.176\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.668\u0026ndash;2.071\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.573\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLong Range Persistent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.286\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.039\u0026ndash;2.099\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.218\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCourse of Disease (yr) (vs.\u0026lt;3 year)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.154\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.091\u0026ndash;0.261\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;3 year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComorbidities with Heart Failure(vs. yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4.262\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.724\u0026ndash;10.539\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.002\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNYHA(%)(vs. I)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.176\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.668\u0026ndash;2.071\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.573\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.256\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.225\u0026ndash;2.154\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.689\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eCurrent status of AF PROs and their consistency with cardiac functional grading\u003c/h2\u003e \u003cp\u003eIn this study, the AF specific questionnaire was assessed using AF6 scale. As a symptom classification tool with fewer items and simple scores, the AF6 scale demonstrated good consistency with cardiac function classification. Scores for 6 individual items and the total AF6 score were positively correlated with cardiac function grade. This indicated that higher AF6 scores correspond to a higher cardiac function grade and the worse PROs.\u003c/p\u003e \u003cp\u003eConsistent with the results of this study, Anna et al reported that the AF6 scale was more sensitive to changes in AF symptom burden compared to the SF-36 scale [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. In 2017, the team further evaluated AF6 symptoms using the AF6 scale and found that the symptoms improved over 6 months. Both AF6 score and cardiac function grades were significantly associated with AF burden [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. These findings support the use of AF6 scale as a reliable tool for evaluating AF specific PROs.\u003c/p\u003e \u003cp\u003eIn this study, the individual item scores on the AF6 scale were 54%, 63.96%, 69.696%, 73.10%, 76.65% and 81.22%, respectively. Anxiety due to atrial fibrillation was identified as the most severe symptom, with a median score of 7 and a maximum of 10. Additional, more than 50% of patients reported significant discomfort, fatigue and anxiety caused by atrial fibrillation. This indicates that all 197 patients included in the study experienced varying degrees of symptom burden, with PROs reflecting a moderate symptom level overall.\u003c/p\u003e \u003cp\u003eThe concept of PROs originated in the 1960s but gained focus in the context of atrial fibrillation only in recent decades[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. The traditional medical approaches have primarily emphasized objective indicators such as the frequency of atrial fibrillation and the incidence of stroke. Incorporating PROs into clinical pathways for patients with atrial fibrillation alongside traditional anatomical, biological, and clinical data, could enhance clinicians\u0026rsquo; awareness of symptoms, improve symptom management, and contribute to better cardiac function outcomes[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cb\u003eAge and course of disease were independent risk factors for reduced event-free survival time in one year in patients with AF\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThis study found that age and disease duration were independent risk factors for reduced event-free survival time within one year. Specifically, older patients and those with a longer disease duration experienced shorter event-free survival times. This may be attributed to the high prevalence of chronic diseases among elderly patients with atrial fibrillation (AF).\u003c/p\u003e \u003cp\u003eWith the gradual establishment of the medical insurance system in China, the role of community health service centers in facilitating hierarchical diagnosis and treatment has not been fully realized. Consequently, the hospitalization demand for elderly patients with AF continues to increase year by year. Consistent with the findings of this study, one survey reported that the hospitalization rate of Chinese residents increased between 2003 and 2018, with residents aged 65 years and older having the highest rates[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAdditionally, data from the Chinese Atrial Fibrillation Registration study (CHINA-AF)[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] showed that among 23,108 patients with AF, more than one-third experienced one or more hospitalizations during an average follow-up of over three years. These findings highlight the importance of comprehensive management of complications in elderly patients with AF and a long disease duration.\u003c/p\u003e \u003cp\u003eFurthermore, relevant institutions should implement appropriate measures to establish a more efficient hierarchical diagnosis and treatment system. This would help reduce the economic burden of medical care for both patients and society as a whole.\u003c/p\u003e \u003cp\u003e \u003cb\u003ePredictive Effect of PROs on Reduced Event-Free Survival Time in One Year Among Patients with AF\u003c/b\u003e \u003c/p\u003e \u003cp\u003eShortened event-free survival time corresponds to an increase in hospitalizations, which can serve as a surrogate marker for the economic burden associated with patient morbidity and healthcare expenditure[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Among the 197 patients included in this study, 81 (41.12%) were hospitalized twice within one year. Similarly, previous studies have reported that approximately 31% of patients with AF required one or more hospitalizations annually[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe factors influencing event-free survival time in patients with AF are multifaceted, encompassing both established cardiovascular risk factors and other variables. However, there are relatively few studies investigating the impact of PROs on event-free survival time in AF patients within one year. In this study, univariate analysis revealed that age, disease duration, comorbidity with heart failure, and cardiac function grade were all associated with an increased likelihood of rehospitalization in AF patients within one year.\u003c/p\u003e \u003cp\u003eTo further explore these relationships, a multivariate COX proportional hazards model was developed, incorporating variables such as age, disease duration, heart failure comorbidity, and cardiac function grade. The analysis demonstrated that patients with a total PROs score\u0026thinsp;\u0026ge;\u0026thinsp;24 had a significantly higher risk of reduced event-free survival time compared to those with a score\u0026thinsp;\u0026lt;\u0026thinsp;24.\u003c/p\u003e \u003cp\u003eThese findings suggest that poor PROs in AF patients may contribute to shortened event-free survival time. Interventions targeting PROs could play a crucial role in improving patient outcomes and extending event-free survival time. This highlights the importance of incorporating PRO-oriented strategies into clinical management for patients with AF.\u003c/p\u003e \u003c/div\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThe evaluation of AF PROs serves as a foundation for the effective management of patients with atrial fibrillation. This study found that AF PROs were at a moderate level overall, with anxiety being the most severe symptom reported by patients. The PROs were strongly aligned with cardiac function classification, further validating their clinical relevance.\u003c/p\u003e \u003cp\u003eThe findings highlight the need to prioritize event-free survival time in elderly AF patients with long disease duration, as these patients are at greater risk of hospitalization. Additionally, poor PROs were associated with a higher likelihood of reduced event-free survival time, underscoring the importance of addressing patient-reported outcomes in clinical care.\u003c/p\u003e \u003cp\u003eAs one of the early studies to explore the relationship between AF PROs and hospitalization rates in China, this research provides a meaningful direction for improving the management of AF patients. By integrating PROs into patient evaluation and management, healthcare providers can develop targeted interventions to enhance patient outcomes and reduce hospitalization rates.\u003c/p\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThis study is a single-center small sample survey; without further exploring the factors affecting heart rate control, patient compliance and other rehospitalization times of AF.\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAUTHOR CONTRIBUTIONS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors listed have made a substantial, direct and intellectual contribution to the work, and approved it for publication.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions:\u003c/strong\u003eDong Zhifeng\u0026nbsp;contributed to the conception of the study;\u003c/p\u003e\n\u003cp\u003eHui Sun\u0026nbsp;performed the experiment;\u003cbr\u003e\u0026nbsp;Chenglin Zhang,\u0026nbsp;Lu Cai\u0026nbsp;contributed significantly to analysis and manuscript preparation;\u003cbr\u003e\u0026nbsp;Hui Sun\u0026nbsp;, Xuemei Li\u0026nbsp;performed the data analyses and wrote the manuscript;\u003cbr\u003e\u0026nbsp;Chenglin Zhang,,Xiaoyan Li\u0026nbsp;helped perform the analysis with constructive discussions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eThis study did not receive funding from external or internal sources.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDisclosures:\u0026nbsp;\u003c/strong\u003eThe authors have no conflicts of interest to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement:\u0026nbsp;\u003c/strong\u003eThe authors wish to thank six hospitals for their support, and acknowledge all participants with AF who assisted with the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability:\u0026nbsp;\u003c/strong\u003eThe datasets generated and analyzed during the current study are not publicly available due to the protection of the privacy of the subjects under investigation but are available from the corresponding author ([email protected])on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate :\u003c/strong\u003eThe study protocol was approved by the ethics committee of the Yancheng School of Clinical Medicine, Nanjing Medical University by the Declaration of Helsinki(No.2023-84). All methods were performed according to relevant guidelines and regulations. Informed consent was obtained from all the participants and/or legal guardians for the study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication :\u003c/strong\u003eNot Applicable.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBrundel BJJM, Ai X, Hills MT, Kuipers MF, Lip GYH, de Groot NMS. Atrial fibrillation. Nat Rev Dis Primers. 2022;8(1):21. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1038/s41572-022-00347-9\u003c/span\u003e\u003cspan address=\"10.1038/s41572-022-00347-9\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Published 2022 Apr 7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKotalczyk A, Lip GY, Calkins H. The 2020 ESC Guidelines on the Diagnosis and Management of Atrial Fibrillation. Arrhythm Electrophysiol Rev. 2021;10(2):65\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.15420/aer.2021.07\u003c/span\u003e\u003cspan address=\"10.15420/aer.2021.07\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHendriks JM, Gallagher C, Middeldorp ME, Lau DH, Sanders P. Risk factor management and atrial fibrillation. Europace. 2021;23(23 Suppl 2):ii52\u0026ndash;60. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/europace/euaa346\u003c/span\u003e\u003cspan address=\"10.1093/europace/euaa346\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSale A, Yu J. Quality of life instruments in atrial fibrillation: a systematic review of measurement properties. Health Qual Life Outcomes. 2022;20(1):143. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12955-022-02057-y\u003c/span\u003e\u003cspan address=\"10.1186/s12955-022-02057-y\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Published 2022 Oct 17.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCai M, Hua W, Zhang N et al. A prognostic nomogram for event-free survival in patients with atrial fibrillation before cardiac resynchronization therapy. BMC Cardiovasc Disord. 2020;20(1):221. Published 2020 May 13. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12872-020-01502-4\u003c/span\u003e\u003cspan address=\"10.1186/s12872-020-01502-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTao S, Yu L, Li J, et al. Association between the triglyceride-glucose index and 1-year major adverse cardiovascular events in patients with coronary heart disease and hypertension. Cardiovasc Diabetol. 2023;22(1):305. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12933-023-02018-9\u003c/span\u003e\u003cspan address=\"10.1186/s12933-023-02018-9\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Published 2023 Nov 8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHumphries B, Cox JL, Parkash R, et al. Patient-Reported Outcomes and Patient-Reported Experience of Patients With Atrial Fibrillation in the IMPACT-AF Clinical Trial. J Am Heart Assoc. 2021;10(15):e019783. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1161/JAHA.120.019783\u003c/span\u003e\u003cspan address=\"10.1161/JAHA.120.019783\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen Y, Tertulien T, Althouse AD, Johnson A, Gisi B, Magnani JW. Association of patient-reported outcomes with hospitalization risk in atrial fibrillation. Am Heart J Plus. 2021;2:100007. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.ahjo.2021.100007\u003c/span\u003e\u003cspan address=\"10.1016/j.ahjo.2021.100007\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKolk MZH, Blok S, De Wildt MCC, et al. Patient-reported outcomes in symptom-driven remote arrhythmia monitoring: evaluation of the Dutch HartWacht-telemonitoring programme. Eur Heart J Digit Health. 2021;2(2):224\u0026ndash;30. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/ehjdh/ztab030\u003c/span\u003e\u003cspan address=\"10.1093/ehjdh/ztab030\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Published 2021 Mar 9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSteinberg BA, Dorian P, Anstrom KJ, et al. Patient-Reported Outcomes in Atrial Fibrillation Research: Results of a Clinicaltrials.gov Analysis. JACC Clin Electrophysiol. 2019;5(5):599\u0026ndash;605. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jacep.2019.03.008\u003c/span\u003e\u003cspan address=\"10.1016/j.jacep.2019.03.008\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSteinberg BA, Woolley S, Li H, et al. Patient-reported outcomes and costs associated with vascular closure and same-day discharge following atrial fibrillation ablation. J Cardiovasc Electrophysiol. 2022;33(8):1737\u0026ndash;44. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/jce.15555\u003c/span\u003e\u003cspan address=\"10.1111/jce.15555\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSteinberg BA, Piccini JPS. Tackling Patient-Reported Outcomes in Atrial Fibrillation and Heart Failure: Identifying Disease-Specific Symptoms? Cardiol Clin. 2019;37(2):139\u0026ndash;46. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.ccl.2019.01.013\u003c/span\u003e\u003cspan address=\"10.1016/j.ccl.2019.01.013\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLorusso D, Mouret-Reynier MA, Harter P, et al. Updated progression-free survival and final overall survival with maintenance olaparib plus bevacizumab according to clinical risk in patients with newly diagnosed advanced ovarian cancer in the phase III PAOLA-1/ENGOT-ov25 trial. Int J Gynecol Cancer. 2024;34(4):550\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1136/ijgc-2023-004995\u003c/span\u003e\u003cspan address=\"10.1136/ijgc-2023-004995\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Published 2024 Apr 1.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGonz\u0026aacute;lez-Mart\u0026iacute;n A, Pothuri B, Vergote I, et al. Progression-free survival and safety at 3.5years of follow-up: results from the randomised phase 3 PRIMA/ENGOT-OV26/GOG-3012 trial of niraparib maintenance treatment in patients with newly diagnosed ovarian cancer. Eur J Cancer. 2023;189:112908. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.ejca.2023.04.024\u003c/span\u003e\u003cspan address=\"10.1016/j.ejca.2023.04.024\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNeuen BL, Heerspink HJL, Vart P, et al. Estimated Lifetime Cardiovascular, Kidney, and Mortality Benefits of Combination Treatment With SGLT2 Inhibitors, GLP-1 Receptor Agonists, and Nonsteroidal MRA Compared With Conventional Care in Patients With Type 2 Diabetes and Albuminuria. Circulation. 2024;149(6):450\u0026ndash;62. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1161/CIRCULATIONAHA.123.067584\u003c/span\u003e\u003cspan address=\"10.1161/CIRCULATIONAHA.123.067584\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVerdonschot JAJ, Hazebroek MR, Krapels IPC, et al. Implications of Genetic Testing in Dilated Cardiomyopathy. Circ Genom Precis Med. 2020;13(5):476\u0026ndash;87. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1161/CIRCGEN.120.003031\u003c/span\u003e\u003cspan address=\"10.1161/CIRCGEN.120.003031\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGeorgiopoulos G, Makris N, Laina A, et al. Cardiovascular Toxicity of Proteasome Inhibitors: Underlying Mechanisms and Management Strategies: JACC: CardioOncology State-of-the-Art Review. JACC CardioOncol. 2023;5(1):1\u0026ndash;21. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jaccao.2022.12.005\u003c/span\u003e\u003cspan address=\"10.1016/j.jaccao.2022.12.005\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Published 2023 Feb 21.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eH\u0026auml;rd\u0026eacute;n M, Nystr\u0026ouml;m B, Kulich K, Carlsson J, Bengtson A, Edvardsson N. Validity and reliability of a new, short symptom rating scale in patients with persistent atrial fibrillation. Health Qual Life Outcomes. 2009;7:65. Published 2009 Jul 15. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/1477-7525-7-65\u003c/span\u003e\u003cspan address=\"10.1186/1477-7525-7-65\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eH\u0026auml;rd\u0026eacute;n M, Nystr\u0026ouml;m B, Bengtson A, Medin J, Frison L, Edvardsson N. Responsiveness of AF6, a new, short, validated, atrial fibrillation-specific questionnaire\u0026ndash;symptomatic benefit of direct current cardioversion. J Interv Card Electrophysiol. 2010;28(3):185\u0026ndash;91. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s10840-010-9487-3\u003c/span\u003e\u003cspan address=\"10.1007/s10840-010-9487-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWu JR, Lennie TA, Frazier SK, Moser DK. Health-Related Quality of Life, Functional Status, and Cardiac Event-Free Survival in Patients With Heart Failure. J Cardiovasc Nurs. 2016;31(3):236\u0026ndash;44. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/JCN.0000000000000248\u003c/span\u003e\u003cspan address=\"10.1097/JCN.0000000000000248\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWu JR, Moser DK. Health-Related Quality of Life Is a Mediator of the Relationship Between Medication Adherence and Cardiac Event-Free Survival in Patients with Heart Failure. J Card Fail. 2021;27(8):848\u0026ndash;56. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.cardfail.2021.03.004\u003c/span\u003e\u003cspan address=\"10.1016/j.cardfail.2021.03.004\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKwon JY, Sawatzky R, Baumbusch J, Ratner PA. Patient-reported outcomes and the identification of subgroups of atrial fibrillation patients: a retrospective cohort study of linked clinical registry and administrative data. Qual Life Res. 2021;30(6):1547\u0026ndash;59. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s11136-021-02777-6\u003c/span\u003e\u003cspan address=\"10.1007/s11136-021-02777-6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKotronoulas G, Kearney N, Maguire R, et al. What is the value of the routine use of patient-reported outcome measures toward improvement of patient outcomes, processes of care, and health service outcomes in cancer care? A systematic review of controlled trials. J Clin Oncol. 2014;32(14):1480\u0026ndash;501. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1200/JCO.2013.53.5948\u003c/span\u003e\u003cspan address=\"10.1200/JCO.2013.53.5948\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGu H, Huang J, Qiao S, Chen X, Cao X. Predictors of participation in atrial fibrillation screening among community residents in China. Heart Lung. 2023;61:59\u0026ndash;64. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.hrtlng.2023.04.015\u003c/span\u003e\u003cspan address=\"10.1016/j.hrtlng.2023.04.015\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDong Z, Du X, Lu S et al. Incidence and predictors of hospitalization in patients with atrial fibrillation: results from the Chinese atrial fibrillation registry study. BMC Cardiovasc Disord. 2021;21(1):146. Published 2021 Mar 19. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12872-021-01951-5\u003c/span\u003e\u003cspan address=\"10.1186/s12872-021-01951-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDouglas-de-Oliveira DW, Chen KJ. Patient-reported measures outcomes: modern evaluation of oral health. BMC Oral Health. 2023;23(1):498. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12903-023-03219-0\u003c/span\u003e\u003cspan address=\"10.1186/s12903-023-03219-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Published 2023 Jul 18.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIrvine I, Hayden R, Greene L, Ryan AG. An Update on Patient-Reported Outcomes in Interventional Radiology: The Future Measure of Our Success. Cardiovasc Intervent Radiol. 2023;46(12):1657\u0026ndash;61. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00270-023-03530-x\u003c/span\u003e\u003cspan address=\"10.1007/s00270-023-03530-x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRozen G, Hosseini SM, Kaadan MI et al. Emergency Department Visits for Atrial Fibrillation in the United States: Trends in Admission Rates and Economic Burden From 2007 to 2014. J Am Heart Assoc. 2018;7(15):e009024. Published 2018 Jul 20. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1161/JAHA.118.009024\u003c/span\u003e\u003cspan address=\"10.1161/JAHA.118.009024\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchak L, Petersen JK, Vinding NE, et al. Temporal changes in incidence, treatment strategies and 1-year re-admission rates in patients with atrial fibrillation/flutter under 65 years of age: A Danish nationwide study. Int J Cardiol. 2023;382:23\u0026ndash;32. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.ijcard.2023.04.007\u003c/span\u003e\u003cspan address=\"10.1016/j.ijcard.2023.04.007\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-cardiovascular-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcar","sideBox":"Learn more about [BMC Cardiovascular Disorders](http://bmccardiovascdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcar/default.aspx","title":"BMC Cardiovascular Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Atrial Fibrillation, Patient-Reported Outcomes, Event-free Survival","lastPublishedDoi":"10.21203/rs.3.rs-6415932/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6415932/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBACKGROUND—\u003c/strong\u003eRepeated episodes of atrial fibrillation (AF) can shorten event-free survival time in patients. Patient-reported outcomes (PROs) directly reflect the health status of patients. However, the relationship between PROs and cardiac event-free survival remains unclear.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOBJECTIVE—\u003c/strong\u003eThis study aimed to investigate the status of PROs and their correlation with cardiac event-free survival time in patients with AF.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMETHODS—\u003c/strong\u003eThis study was a prospective study. Patients with non-valvular atrial fibrillation treated in the Department of Cardiology of one three third-class hospital in Yancheng from May 2023 to April 2024 were enrolled. The investigation was performed using general information questionnaire and AF-specific questionnaire 6 (AF6). At baseline, demographic and clinical data of the patients were collected. Major adverse cardiovascular events and one-year event-free survival time after discharge were obtained by telephone follow-ups and review of medical records.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRESULTS\u003c/strong\u003e—\u003cstrong\u003e \u003c/strong\u003eAmong the 197 patients investigated, the mean age was (74.1 ± 9.0) years old, and 106 (53.8%) were women. The mean AF6 score was (24.29 ± 8.33), with over 50% of patients scoring ≥ 1 point on all six items. A significant correlation was observed between cardiac function grading and PROs (r = 0.360, P \u0026lt; 0.001). Kaplan-Meier plots and log-rank tests demonstrated that patients with poor PROs had significantly worse cardiac event-free survival (P = 0.043).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCONCLUSION\u003c/strong\u003e—The PROs of patients with AF were at a moderate level. Poor PROs were associated with the shorter cardiac\u003cstrong\u003e \u003c/strong\u003eevent-free survival times. These findings highlight the requirement for intervention studies aimed at improving PROs.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number \u003c/strong\u003eNot applicable.\u003c/p\u003e","manuscriptTitle":"Correlating Patient-Reported Outcomes and Cardiac Event-Free Survival Time in Patients with Atrial Fibrillation: A Prospective Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-20 06:45:42","doi":"10.21203/rs.3.rs-6415932/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"311588042951874653423526228069801480248","date":"2026-05-01T03:43:05+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-03T15:31:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"312991635677557417142371404013920204645","date":"2025-05-29T09:23:20+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-14T16:46:18+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-13T08:41:26+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-04-21T07:18:39+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-19T15:44:28+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Cardiovascular Disorders","date":"2025-04-19T15:43:20+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-cardiovascular-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcar","sideBox":"Learn more about [BMC Cardiovascular Disorders](http://bmccardiovascdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcar/default.aspx","title":"BMC Cardiovascular Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"62c2f30e-fbd5-4366-b831-6abec52cabfb","owner":[],"postedDate":"May 20th, 2025","published":true,"recentEditorialEvents":[{"type":"reviewerAgreed","content":"311588042951874653423526228069801480248","date":"2026-05-01T03:43:05+00:00","index":83,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-05-20T06:45:42+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-20 06:45:42","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6415932","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6415932","identity":"rs-6415932","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}