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Original research article
Association of income and health-related quality of life in atrial fibrillation
  1. Emily Guhl1,
  2. Andrew Althouse1,
  3. Michael Sharbaugh1,
  4. Alexandra M Pusateri2,
  5. Michael Paasche-Orlow3 and
  6. Jared W Magnani1,2
  1. 1Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
  2. 2Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  3. 3Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
  1. Correspondence to Dr Jared W Magnani; magnanij{at}


Objective Health-related quality of life (HRQoL) is a patient-centred benchmark promoted by clinical guidelines in atrial fibrillation (AF). Income is associated with health outcomes, but how income effects HRQoL in AF has limited investigation.

Methods We enrolled a convenience cohort with AF receiving care at a regional healthcare system and assessed demographics, medical history, AF treatment, income, education and health literacy. We defined income as a categorical variable (<$20 000; $20 000–$49 999; $50 000–$99 999; >$100 000). We used two complementary HRQoL measures: (1) the atrial fibrillation effect on quality of life (AFEQT), measuring composite and domain scores (daily activity, symptoms, treatment concerns, treatment satisfaction; range 0–100); (2) the 12-item Short Form Survey (SF-12), measuring general HRQoL with physical and mental health domains (range 0–100). We related income to HRQoL and adjusted for relevant covariates.

Results In 295 individuals with AF (age 71±10, 40% women), we observed significant differences in HRQoL by income. Higher mean composite AFEQT scores were observed for higher income groups: participants with income <$20 000 had the lowest HRQoL (n=35, 68.2±21.4), and those with income >$100 000 had the highest HRQoL (n=64, 81.9±17.0; p=0.04). We also observed a significant difference by income in the AFEQT daily activity domain (p=0.02). Lower income was also associated with lower HRQoL in the mental health composite score of the SF-12 (59.7±21.5, income <$20 000 vs 79.3±16.3, income >$100 000; p<0.01).

Conclusion We determined that income was associated with HRQoL in a cohort with prevalent AF. Given the marked differences, we consider income as essential for understanding patient-centred outcomes in AF.

  • atrial fibrillation
  • epidemiology
  • public health

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  • Contributors EG: conception, design, drafting of the manuscript and manuscript revision. AA: analysis, manuscript revision. MS: analysis, manuscript revision. AMP: data collection, design, manuscript revision. MP-O: manuscript revision. JWM: conception, design and drafting of the manuscript, manuscript revision for important intellectual content and final approval of the manuscript.

  • Funding This work was supported by Grant 2015084 from the Doris Duke Charitable Foundation and by NHLBI award R56143010.

  • Competing interests None declared.

  • Patient consent for publication All participants provided written informed consent.

  • Ethics approval The University of Pittsburgh Institutional Review Board approved the study protocol.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement The anonymized individual participant data will be shared onreasonable request.

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