Are we measuring what matters? A critical review of quality-of-life instruments in atrial fibrillation

Abstract

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and is associated with increased morbidity, mortality, and healthcare utilisation. Beyond clinical outcomes, AF significantly impairs patients' quality of life (QoL). Despite the recognition of QoL as a key patient-reported outcome measure (PROM), there is no consensus on the optimal tool for assessing the multidimensional burden of AF. This study critically reviews five major QoL instruments – AFEQT, EQ-5D, SF-36, MLHFQ, and AFSSS – focusing on their coverage of ten core domains: physical functioning, symptoms, emotional well-being, social functioning, cognitive function, treatment satisfaction, economic burden, health perception, sexual health, and sleep quality. A structured literature review was conducted in PubMed, Scopus, Web of Science, and Cochrane Library. AFEQT emerged as the most comprehensive AF-specific instrument, although gaps remained in underrepresented domains such as cognition, sexuality, and economic impact. Generic instruments, while useful for comparisons and health economics, lacked sensitivity to AF-specific issues. This review underscores the need for more holistic, patient-centred instruments that align QoL measurement with domains most relevant to patients' lived experiences. Future research should integrate digital health tools and PROM platforms to enhance real-time monitoring and individualised care strategies. Atrial fibrillation; quality of life; patient-reported outcomes; measurement instruments; AFEQT