The impact of screening-detected atrial fibrillation and associated outcomes on quality of life.

Purpose: To investigate health-related quality of life (HRQoL) after atrial fibrillation (AF) detected by screening compared with conventional AF diagnosis.

Methods: We used HRQoL data (EQ-5D-5L) from 6004 persons randomised to AF screening with implantable loop recorder and treatment (n = 1501) or to usual care (n = 4503). Annual assessments yielded individual EQ-5D-5L-index (worst=-0.76 best = 1.00) and EQ-VAS scores (Visual Analogue Scale, 0 = worst, 100 = best). Changes were estimated with linear mixed models from before to after incident AF, stroke, and major bleeding. Interaction analyses assessed differences between the randomisation groups.

Results: During three years of follow-up, 693 of 6004 (12%) participants were diagnosed with AF (Screening: 424 of 1501 (28%), usual care: 269 of 4503 (6.0%)), with 636 alive at year three. For participants developing AF, the EQ-5D-5L index score in the screening group declined from 0.87 before to 0.85 after AF (p < 0.001), and from 0.83 before to 0.79 after AF (p < 0.001) in usual care, with less HRQoL decline in the screening group (p = 0.019). For patients developing stroke and major bleeding, the EQ-5D-5L index scores in the screening group declined from 0.82 to 0.78 (p < 0.001) and 0.82 to 0.76 (p < 0.001) before and after diagnosis, and from 0.84 to 0.76 (p < 0.001) and 0.85 to 0.76 (p < 0.001) in usual care, without differences between the randomisation groups. All EQ-VAS analyses yielded very similar results.

Conclusion: AF detected through screening had little negative impact on HRQoL compared with AF detected by usual care. Stroke and major bleeding were followed by large HRQoL reductions, regardless of randomisation group.

Trial registration: The LOOP study is registered at ClinicalTrials.gov, identifier: NCT02036450.