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BACKGROUND: Health-related quality of life (HRQoL) is worse in patients with atrial fibrillation (AF) compared with other populations. Factors affecting HRQoL in patients with AF are not fully clarified. Illness perceptions are important determinants of disease management and may affect HRQoL.

OBJECTIVE: The aims of this study were to describe illness perceptions and HRQoL in women and men with AF and to explore the relationship between illness perceptions and HRQoL in patients with AF.

METHODS: This cross-sectional study included 167 patients with AF. Patients completed the Revised Illness Perception Questionnaire and HRQoL questionnaires: Arrhythmia-Specific questionnaire in Tachycardia and Arrhythmias, the three-level version of the EuroQol 5-dimensional questionnaire, and EuroQol visual analog scale. Subscales of the Revised Illness Perception Questionnaire significant in correlation analysis with the Arrhythmia-Specific questionnaire in Tachycardia and Arrhythmias HRQoL total scale were included in a multiple linear regression model.

RESULTS: Mean age was 68.7 ± 10.4 years, and 31.1% were women. Women reported lower personal control (P = .039) and worse HRQoL measured with the Arrhythmia-Specific questionnaire in Tachycardia and Arrhythmias physical subscale (P = .047) and the EuroQol visual analog scale (P = .044) compared with men. Illness identity (P < .001), consequences (P = .031), emotional representation (P = .014), and timeline cyclical (P = .022) were related to and adversely affected HRQoL.

CONCLUSIONS: This study found a relationship between illness perceptions and HRQoL. Some subscales of illness perceptions negatively affected HRQoL in patients with AF, which indicates that efforts to change illness perceptions may be helpful in improving HRQoL. Patients should be given the opportunity to talk about the disease, their symptoms, their emotions, and the consequences of the disease to enable increased HRQoL. A challenge for healthcare will be to design support for each patient based on his/her illness perceptions.

Aims: To compare patient-reported outcomes (PROs) in patients newly (<6 months) diagnosed with atrial fibrillation (AF) with those who have had a longer diagnosis (≥6 months) and to investigate whether or not these outcomes change over a 6-month period.

Methods and results: In this longitudinal survey study, 129 patients with AF completed the Revised Illness Perception Questionnaire, the Arrhythmia-Specific questionnaire in Tachycardia and Arrhythmia, and the Hospital Anxiety and Depression Scale at baseline and after 6 months. At baseline, patients newly diagnosed with AF (n = 53), compared with patients with a previous diagnosis (n = 76), reported AF as more temporary (P = 0.003) and had a higher belief in personal and treatment control (P = 0.004 and P = 0.041, respectively). At a 6-month follow-up, patients newly diagnosed reported a lower symptom burden (P = 0.004), better health-related quality of life (HRQoL); (P = 0.015), and a higher personal control (P < 0.001) than patients previously diagnosed. Over time, in patients newly diagnosed, symptom burden and the anxiety symptom score decreased (P = 0.001 and P = 0.014, respectively) and HRQoL improved (P = 0.002).

Conclusion: Patients newly diagnosed with AF reported more positive PROs both at baseline and at a 6-month follow-up than patients with a previous diagnosis of AF. Therefore, it is important to quickly capture patients newly diagnosed to support their belief in their own abilities. Such support may, alongside medical treatments, help patients manage the disease, which may lead to reduced symptom burden and better HRQoL over time.

AIM: To explore the experiences of living with symptomatic atrial fibrillation.

DESIGN: This study, with a descriptive qualitative adesign, was performed using semi-structured individual interviews.

METHOD: Six women and nine men with symptomatic atrial fibrillation were included. The transcribed interviews were analysed using qualitative content analysis. The COREQ checklist was followed.

RESULTS: The analysis resulted in a main theme, namely balancing life and included the themes striving for illness control, becoming a receiver or an active partner in care and dealing with changed self-image. The participants strived to understand their illness, prevent attacks and manage anxiety. Some of the participants were not involved in decision-making, were uninformed about self-care measures, reported a lack of continuity in care and felt that the doctors focused on information about the medical part of care.

Introduction: Mineralocorticoid receptor antagonists (MRAs) reduce mortality and morbidity in patients with heart failure and reduced ejection fraction (HFrEF), but are largely underused. We evaluated the frequency, motives, predictors and outcomes of MRA discontinuation in a real-world heart failure population.

Methods and results: This was a single-centre, retrospective cohort study where medical record-based data were collected on patients with HFrEF between 2010 and 2018. In the final analysis, 572 patients were included that comprised the continued MRA group (n=275) and the discontinued MRA group (n=297). Patients that discontinued MRA were older, had a higher comorbidity index and a lower index estimated glomerular filtration rate (eGFR). Predictors of MRA discontinuations were increased S-potassium, lower eGFR, lower systolic blood pressure, higher frequency of comorbidities and a higher left ventricular ejection fraction. The most common reason for MRA discontinuation was renal dysfunction (n=97, 33%) with 59% of these having an eGFR <30 mL/min/1.73m 2, and elevated S-potassium (n=71, 24%) with 32% of these having an S-potassium >5.5 mmol/L. Discontinuation of MRA increased the adjusted risk of all-cause mortality (HR 1.48; 95% CI 1.07 to 2.05; p=0.019).

Conclusions: Half of all patients with HFrEF initiated on MRA discontinued the treatment. A substantial number of patients discontinued MRA without meeting the guideline-recommended levels of eGFR and S-potassium where mild to moderate hyperkalaemia seems to be the most decisive predictor. Further, MRA discontinuation was associated with increased adjusted risk of all-cause mortality.

Aims: Impaired renal function is a major contributor to the low proportion of mineralocorticoidreceptor antagonist (MRA) treatment in patients with heart failure with reduced ejection fraction(HFrEF). Our aims were to investigate the impact of MRA treatment on all-cause mortalityand worsening renal function (WRF) in patients with HFrEF and moderately impairedrenal function.

Methods: Retrospective data between 2010–2018 on HFrEF patients from a single-centre hospitalwith estimated glomerular renal function (eGFR) < 60 ml/min/1.73 m2 were analysed. WRF was defined as a decline of by eGFR > 20%.

Results: 416 patients were included, 131 patients on MRA and 285 without MRA, mean age was 77years (SD ± 9) and 82 years (SD ± 9), respectively. Median follow-up was 2 years. 128patients (32%) experienced WRF, 25% in the MRA group and 30% in patients without MRA(p = 0.293). In multivariable analysis, hospitalization for heart failure and systolic blood pressurewere associated with WRF (p = 0.015 and p = <0.001), but not use of MRA (p = 0.421).MRA treatment had no impact on the risk of adjusted all-cause mortality (HR 0.93; 95% CI,0.66–1.32 p = 0.685). WRF was associated with increased adjusted risk of all-cause mortality(HR 1.43; 95% CI, 1.07–1.89 p = 0.014). Use of MRA did not increase the adjusted overallrisk of mortality even when experiencing WRF (HR 1.15; 95% CI, 0.81–1.63 p = 0.422).

Conclusion: In this cohort of elderly HFrEF patients with moderately impaired renal function, MRA didnot increase risk for WRF or all-cause mortality.

Aims: Glomerular filtration rate is an important factor in management of heart failure (HF). Our objective was to validate eight creatinine-based equations for estimating glomerular filtration rate (eGFR) in an HF population against measured glomerular filtration rate.

Methods and results: One hundred forty-six HF patients (mean age 68 +/- 13 years, mean left ventricular ejection fraction 45% +/- 15) within a single-centre hospital that underwent Cr-51-EDTA clearance between 2010 and 2018 were included in this retrospective study. eGFR was estimated by means of Cockcroft-Gault ideal and actual weight, the Modification of Diet in Renal Disease Study (MDRD), simplified MDRD with isotope dilution mass spectroscopy traceable calibration, the Chronic Kidney Disease Epidemiology Collaboration, revised Lund-Malmo, full age spectrum, and the Berlin Initiative Study 1. Mean measured glomerular filtration rate was 42 mL/min/1.73 m(2). Pearson's correlation coefficient (r) had the highest precision for MDRD (r = 0.9), followed by revised Lund-Malmo (r = 0.88). All equations except MDRD (mean difference -4.8%) resulted in an overestimation of the renal function. The accuracy was below 75% for all equations except MDRD.

Conclusions: None of the exclusively creatinine-based methods was accurate in predicting eGFR in HF patients. Our findings suggest that more accurate methods are needed for determining eGFR in patients with HF.

Study Objectives: The aim of the study was to investigate the effect of ambient temperature on sleep, sleep apnea, and morning alertness in patients with obstructive sleep apnea. Design: Randomized controlled trial. Setting: In-hospital investigations. Participants: Forty patients with obstructive sleep apnea naive to treatment, with an apnea-hypopnea index of 10-30. Interventions: Three different nights in room temperatures of 16 degrees C, 20 degrees C, and 24 degrees C. Measurements: Overnight polysomnography and Karolinska Sleepiness Scale. Results: The obstructive apnea-hypopnea index was 30 +/- 17 at 16 degrees C room temperature, 28 +/- 17 at 20 degrees C, and 24 +/- 18 at 24 degrees C. The obstructive apnea-hypopnea index was higher at 16 degrees C room temperature versus 24 degrees C (P = 0.001) and at 20 degrees C room temperature versus 24 degrees C (P = 0.033). Total sleep time was a mean of 30 min longer (P = 0.009), mean sleep efficiency was higher (77 +/- 11% versus 71 +/- 13% respectively, P = 0.012), and the patients were significantly more alert according to the Karolinska Sleepiness Scale (P < 0.028) in the morning at 16 degrees C room temperature versus 24 degrees C. The amount of sleep in different sleep stages was not affected by room temperature. Conclusions: Untreated patients with obstructive sleep apnea sleep longer, have better sleep efficiency, and are more alert in the morning after a night's sleep at 16 degrees C room temperature compared with 24 degrees C, but obstructive sleep apnea is more severe at 16 degrees C and 20 degrees C compared with 24 degrees C.

Background: Obstructive sleep apnea is a common disorder, especially in men. Patients with this condition often snore and suffer from excessive daytime sleepiness. It is a treatable condition related to cardiovascular disease, road traffic accidents and obesity.

Aims: To study whether snoring and witnessed sleep apnea are related to diabetes mellitus and whether sleepy subjects who snore or report sleep apneas drive more than others. To investigate whether sleep apnea is related to stroke, mortality and myocardial infarction in patients with coronary artery disease. To study the effect of ambient temperature on sleep apnea, morning alertness and sleep quality in patients with obstructive sleep apnea.

Methods and results: Questions on snoring, sleep apnea, daytime sleepiness and yearly driving distance were included in the northern Sweden component of the WHO MONICA study. Analyzed were 7905 randomly selected men and women aged 25-79 years. Snoring and witnessed sleep apnea were related to diabetes mellitus in women, (OR 1.58, p = 0.041 and OR 3.29, p = 0.012 respectively), independent of obesity, age and smoking, but not in men. Sleepy snoring men drove a mean of 22566 km per year which was more than others who drove 17751 km per year independent of age, BMI, smoking and physical activity (p = 0.02). Sleepy men reporting sleep apnea also drove more (p = 0.01). 392 men and women with coronary artery disease referred for coronary angiography were examined with overnight sleep apnea recordings and followed for 10 years. Sleep apnea was recorded in 211 (54%) of patients at baseline. Stroke occurred in 47 (12%) patients at follow up. Sleep apnea was associated with an increased risk of stroke (HR 2.89, 95% CI 1.37 - 6.09, p = 0.005) independent of age , BMI, left ventricular function, diabetes mellitus, gender, intervention, hypertension, atrial fibrillation, a previous stroke or TIA and smoking. The risk of stroke increased with the severity of sleep apnea. 40 patients with obstructive sleep apnea were investigated with overnight polysomnography in ambient temperatures of 16°C, 20°C and 24°C in random order. Total sleep time was a mean of 30 minutes longer (p = 0.009), sleep efficiency higher (p = 0.012), patients were more alert in the morning (p = 0.028), but sleep apnea was more severe when sleeping in 16°C (p = 0.001) and 20°C (p = 0.033) vs. 24°C. The AHI was 30 ± 17 in 16ºC room temperature, 28 ± 17 in 20°C and 24 ± 18 in 24°C.

Conclusions: Snoring and witnessed sleep apneas are related to diabetes mellitus in women. Sleepy men who snore or report sleep apnea drive more than others. Sleep apnea is independently associated with the risk of stroke among patients with coronary artery disease. Subjects with obstructive sleep apnea sleep longer, are more alert in the morning after a night’s sleep, but sleep apnea is more severe when sleeping in a colder environment.

Background

Gender differences in the relationship of snoring and diabetes mellitus are mainly unknown. We aimed to analyze the relationship between snoring, witnessed sleep apnea and diabetes mellitus and to analyze possible gender related differences in an unselected population.

Methods

Questions on snoring and witnessed sleep apneas were included in the Northern Sweden component of the WHO, MONICA study. Invited were 10,756 men and women aged 25–79 years, randomly selected from the population register.

Results

There were 7905 (73%) subjects, 4047 women and 3858 men who responded to the questionnaire and attended a visit for a physical examination. Habitual snoring was related to diabetes mellitus in women, with an adjusted odds ratio (OR) = 1.58 (95% confidence interval (CI) 1.02–2.44, p = 0.041) independent of smoking, age, body mass index and waist circumference. Witnessed sleep apnea was also independently related to diabetes mellitus in women, with an adjusted OR = 3.29 (95% CI 1.20–8.32, p = 0.012). Neither snoring, nor witnessed sleep apneas were associated with diabetes mellitus among men, except for witnessed sleep apnea in men aged 25–54 years old. They had an adjusted OR = 3.84 (95% CI 1.36–10.9, p = 0.011) for diabetes mellitus.

Conclusions

Snoring and witnessed sleep apneas are related to diabetes mellitus in women. Witnessed sleep apnea is related to diabetes mellitus in men younger than 55 years old.

Objective

To investigate whether subjects with daytime sleepiness who snore or report witnessed sleep apneas drive more than others.

Methods

Questions on snoring, witnessed sleep apnea, excessive daytime sleepiness and driving distance per year were included in the Northern Sweden component of the WHO, MONICA study. Invited were 10756 subjects aged 25–79 years, randomly selected from the population register.

Results

There were 7905 (73%) subjects, 3858 men and 4047 women who responded to the questionnaire and attended a visit for a physical examination. Habitually snoring men with daytime sleepiness drove a mean of 22566 (95% CI 18550–26582) km a year, which was significantly more than non-snoring men without excessive daytime sleepiness who drove 17751 (95% CI 17076–18427) km a year, p = 0.02, after adjustments for age, body mass index, smoking and physical activity. Men reporting witnessed sleep apnea and excessive daytime sleepiness also drove more than their counterparts in adjusted analysis, p = 0.01. Women reporting daytime sleepiness and witnessed apnea tended to drive more, while snoring women with daytime sleepiness did not.

Conclusions

Men suffering from excessive daytime sleepiness who snore habitually or report witnessed sleep apneas drive significantly more than others.