Abstract：
OBJECTIVE: To validate the European Heart Rhythm Association (EHRA) symptom classification in atrial fibrillation (AF) and test whether its discriminative ability could be improved by a simple modification.
RESULTS: We compared the EHRA classification with three quality of life (QoL) measures: the AF-specific Atrial Fibrillation Effect on QualiTy-of-life (AFEQT) questionnaire; two components of the EQ-5D instrument, a health-related utility which can be used to calculate cost-effectiveness, and the visual analogue scale (VAS) which demonstrates patients\' own assessment of health status. We then proposed a simple modification [modified EHRA (mEHRA)] to improve discrimination at the point where major treatment decisions are made. quality of life data and clinician-allocated EHRA class were prospectively collected on 362 patients with AF. A step-wise, negative association was seen between the EHRA class and both the AFEQT and the VAS scores. Health-related utility was only significantly different between Classes 2 and 3 (P < 0.001). We developed and validated the mEHRA score separating Class 2 (symptomatic AF not limiting daily activities), based on whether the patients were \'troubled by their AF\' (Class 2b) or not (Class 2a). This produced two distinct groups with lower AFEQT and VAS scores and, importantly, both clinically and statistically significant lower health utility (Δutility 0.9, P = 0.01) in Class 2b than Class 2a.
CONCLUSIONS: Based on patients\' own assessment of their health status and the disease-specific AFEQT, the EHRA score can be considered a useful semi-quantitative classification. The mEHRA score has a clearer separation in health utility to assess the cost efficacy of interventions such as ablation, where Class 2b symptoms appear to be the appropriate treatment threshold.
RESULTS: We compared the EHRA classification with three quality of life (QoL) measures: the AF-specific Atrial Fibrillation Effect on QualiTy-of-life (AFEQT) questionnaire; two components of the EQ-5D instrument, a health-related utility which can be used to calculate cost-effectiveness, and the visual analogue scale (VAS) which demonstrates patients\' own assessment of health status. We then proposed a simple modification [modified EHRA (mEHRA)] to improve discrimination at the point where major treatment decisions are made. quality of life data and clinician-allocated EHRA class were prospectively collected on 362 patients with AF. A step-wise, negative association was seen between the EHRA class and both the AFEQT and the VAS scores. Health-related utility was only significantly different between Classes 2 and 3 (P < 0.001). We developed and validated the mEHRA score separating Class 2 (symptomatic AF not limiting daily activities), based on whether the patients were \'troubled by their AF\' (Class 2b) or not (Class 2a). This produced two distinct groups with lower AFEQT and VAS scores and, importantly, both clinically and statistically significant lower health utility (Δutility 0.9, P = 0.01) in Class 2b than Class 2a.
CONCLUSIONS: Based on patients\' own assessment of their health status and the disease-specific AFEQT, the EHRA score can be considered a useful semi-quantitative classification. The mEHRA score has a clearer separation in health utility to assess the cost efficacy of interventions such as ablation, where Class 2b symptoms appear to be the appropriate treatment threshold.
摘要：
目的：验证欧洲心律协会（EHRA）在心房颤动（AF）中的症状分类，并测试其辨别能力是否可以通过简单的修改得到改善。
结果：我们将EHRA分类与三种生活质量（QoL）指标进行了比较：房颤特异性心房颤动对生活质量的影响（AFEQT）问卷；EQ-5D仪器的两个组成部分，可用于计算成本效益的与健康相关的效用，以及显示患者自身健康状况评估的视觉模拟量表(VAS)。然后，我们提出了一个简单的修改[修改的EHRA（mEHRA）]，以改善做出重大治疗决定的地方的歧视。我们前瞻性收集了362例房颤患者的生活质量数据和临床医师分配的EHRA类别.一步一步，EHRA类别与AFEQT和VAS评分呈负相关.与健康相关的效用仅在第2类和第3类之间存在显着差异（P<0.001）。我们开发并验证了mEHRA评分，将2级（症状性房颤不限制日常活动）分开，根据患者是否受到房颤困扰（2b级）或不（2a级）。这产生了两个不同的组，具有较低的AFEQT和VAS评分，重要的是,2b类的临床和统计学上显着的健康效用（Δ效用0.9，P=0.01）均低于2a类。
结论：基于患者自己对其健康状况和疾病特异性AFEQT的评估，EHRA评分可被认为是一种有用的半定量分类.mEHRA评分在评估消融等干预措施的成本效益方面具有更清晰的卫生效用分离。其中2b类症状似乎是适当的治疗阈值。
结果：我们将EHRA分类与三种生活质量（QoL）指标进行了比较：房颤特异性心房颤动对生活质量的影响（AFEQT）问卷；EQ-5D仪器的两个组成部分，可用于计算成本效益的与健康相关的效用，以及显示患者自身健康状况评估的视觉模拟量表(VAS)。然后，我们提出了一个简单的修改[修改的EHRA（mEHRA）]，以改善做出重大治疗决定的地方的歧视。我们前瞻性收集了362例房颤患者的生活质量数据和临床医师分配的EHRA类别.一步一步，EHRA类别与AFEQT和VAS评分呈负相关.与健康相关的效用仅在第2类和第3类之间存在显着差异（P<0.001）。我们开发并验证了mEHRA评分，将2级（症状性房颤不限制日常活动）分开，根据患者是否受到房颤困扰（2b级）或不（2a级）。这产生了两个不同的组，具有较低的AFEQT和VAS评分，重要的是,2b类的临床和统计学上显着的健康效用（Δ效用0.9，P=0.01）均低于2a类。
结论：基于患者自己对其健康状况和疾病特异性AFEQT的评估，EHRA评分可被认为是一种有用的半定量分类.mEHRA评分在评估消融等干预措施的成本效益方面具有更清晰的卫生效用分离。其中2b类症状似乎是适当的治疗阈值。
