Quality of life, care needs and priorities in atrial fibrillation: the impact of number and patterns of comorbidities

Abstract

PURPOSE: Atrial fibrillation (AF) often coexists with multiple chronic conditions, worsening health-related quality of life (HRQoL) and increasing the burden on patients and caregivers. While multimorbidity is known to worsen clinical outcomes, the role of distinct comorbidity patterns in shaping patients' experience remains unclear. This cross-sectional study assessed whether the number and patterns of comorbidities differentially affect HRQoL, care needs, and priorities of AF patients and caregivers. METHODS: An online survey on living with AF and multimorbidity was disseminated between May 2022 and January 2023 in the UK, Italy, Spain, Romania, and Denmark. The analysis included 633 AF patients (46.9% females, median age 73 years) and 198 caregivers (26.8% females, median age 57 years). Exposure variables were the number and patterns (derived through latent class analysis) of comorbidities. Outcomes included HRQoL (measured with the EQ-5D-3L), perceived management problems and health priorities assessed through a structured questionnaire developed ad hoc for the survey. RESULTS: Three patterns emerged: unspecific (65.5%), diabetes-kidney-liver (18.2%), and complex (16.4%). More comorbidities and belonging to the complex pattern were associated with worse HRQoL, mainly due to limited mobility, dependency, and pain. Main issues were managing multiple diseases, medi ions, and appointments. The diabetes-kidney-liver group prioritized improving quality of life (OR=3.08, 95%CI:1.68-6.00) and living longer (OR=1.67, 95%CI:1.05-2.64), while pain relief was a distinct priority in the complex pattern (OR=2.32, 95%CI:1.38-3.86). CONCLUSION: Both number and combinations of AF comorbidities shape patients' and caregivers' experiences. Considering comorbidity profiles can help define targeted care plans and caregiver support initiatives.