Instruments to assess symptom burden and quality of life among patients with atrial fibrillation (AF) have not been well evaluated in community practice or associated with patient outcomes. The purpose of this study is to evaluate AF symptoms and their association to patient outcome.

Between March and June 2017, we conducted a prospective, observational NATURE-AF registry (National Tunisian Registry of Atrial Fibrillation) with a 1-year follow-up period. In total, 912 patients with a recently diagnosed AF were included. Demographics, clinical and etiological characteristics as well as arrhythmia management strategies and one year outcome were recorded. The association between AF-related symptoms and outcomes was assessed using logistic regression.

The mean age was 64.2 years±13.4; fifty two percent of patients were female. AF related to valvular heart disease was detected in 23.2% patients. Symptoms severity evaluated using the European Heart Rhythm Association (EHRA) classification system showed 57.9% symptomatic patients (EHRA=2) and 38.4% patients had severe or disabling symptoms (EHRA 3–4). 96.9% of patients were on vitamin K antagonist and 13.8% of patients received antiplatelet therapy. During follow-up, we noted 0.9% symptomatic stroke, 0.7% systemic thromboembolism, 6.0% incident heart failure, 11.5% cause-specific hospitalization, 0.5% major bleeding, and 5.6% cases of death. Over 1- year of follow-up, AF symptoms were associated with a high risk of heart failure (OR=4.2, P<0.001), major bleeding (OR=16.9, P=0.012) and stroke (OR =3.6, P=0.078). There is no association between AF symptoms and hospitalization (OR=1.3, P=0.293) for EHRA ≥2 versus EHRA 1, and death (OR=0.9, P=0.663).

NATURE AF registry showed most patients with AF were symptomatic. The major complication was heart failure. AF symptoms were associated with higher risk of heart failure, major bleeding, stroke but not death nor hospitalization.