ACC 2017: Quality of care may improve quality of life in AF patients in Japan, says first of its kind study

March 19, 2017: Adherence to updated AHA/ACC atrial fibrillation performance measures might lead to improvement of patients’ quality of life in Japan, but warrants further study, say researchers.

A recent study by DCRI researchers presented at the annual ACC conference in Washington, D.C. aimed to explore whether compliance to updated American Heart Association/American College of Cardiology (AHA/ACC) quality measures will lead to improved outcomes and better quality of life in patients with atrial fibrillation (AF) in Japan.

AF is the most common sustained arrhythmia in adults in the United States and around the world, impairing both functional status and quality of life of those affected. In countries like Japan, where no instruments or measures exist for evaluating the quality of care for patients with AF, it can be difficult to assess and implement means to improve the care of these patients.

“Being able to manage AF appropriately is a pressing public health challenge in Japan,” said DCRI Fellow Taku Inohara, MD, lead author of the study. “Due to a lack of indicators evaluating the quality of care for patients with AF in the country, we evaluated the 2016 AHA/ACC clinical performance and quality measures and their association with clinical outcomes and quality of life for AF patients in Japan.”

Measure sets developed by the ACC/AHA are intended to provide practitioners and institutions tools to measure the quality of care provided and identify opportunities for improvement. While they have been developed in the context of the U.S. health system, they can also be applied in other countries, since measures for high quality care do not vary based on the country they are studied or implemented in.

To assess the quality of AF care in Japan, investigators evaluated adherence with the AF performance measures based on the 2016 AHA/ACC criteria in the Japanese KiCS-AF multicenter outpatient AF registry.

“The Keio Inter-hospital Cardiovascular Studies for AF (KiCS-AF) is a clinician-initiated, prospective, 10-center, outpatient AF registry designed to collect clinical variables and outcome measures for AF patients,” Inohara said.

With its coordinating center at Keio University in Tokyo, it currently enrolls around 2000 patients, all diagnosed with AF within the last six months.

The researchers also assessed the association between adherence to these guidelines with clinical outcomes and quality of life using the Atrial Fibrillation Effect on Quality-of-Life (AFEQT) questionnaire, which is a 20-item survey using 7-point response scales, which measures AF-specific quality of life.

In this study, the patient was deemed ‘adherent’ when all applicable components of the performance measures for outpatient settings were satisfied. The researchers found that among 1,874 patients with AF, a total of 863 patients were fully adherent to the AF performance measures. Adherence was more frequently achieved in patients managed with rhythm control compared with rate control alone.

After a one-year follow-up, it was also found that the AFEQT global scores were likely to be higher in adherent patients compared with non-adherent patients. The “Treatment Concern” and “Satisfaction” sub-domains in AFEQT were also significantly improved during the follow-up.

“This means that high quality of care according to performance measures might provide patients with a deeper understanding about their disease and facilitate shared decision-making,” Inohara said.

According to Inohara, there is an important opportunity to improve the quality of care in patients with AF in Japan and though this study demonstrates that adherence to the AF performance measures might lead to the improvement of patients’ quality of life, further and more in-depth studies are needed to evaluate its association with clinical outcomes.

In addition to Inohara, other researchers included Shun Kohsaka, Takehiro Kimura, Ikuko Ueda, Nobuhiro Ikemura, Mitsuaki Sawano, Kazuaki Nakajima, Shin Kashimura, Akira Kunitomi, Yoshinori Katsumata, Takahiko Nishiyama, Nobuhiro Nishiyama, Yoshiyasu Aizawa, Keiichi Fukuda and Seiji Takatsuki.