# Determinants of quality of life in older adults with atrial fibrillation: a structural equation modeling analysis

## TL;DR

This study identifies factors affecting quality of life in older adults with atrial fibrillation and shows how these factors are connected through direct and indirect pathways.

## Contribution

The novel contribution is the use of structural equation modeling to reveal both direct and indirect effects of multiple determinants on quality of life in atrial fibrillation patients.

## Key findings

- Age, income, AF type, depression, and social support had both direct and indirect effects on quality of life.
- Social support and psychological factors significantly influence quality of life through combined direct and indirect pathways.
- Personalized nursing interventions targeting these factors could improve health outcomes for older AF patients.

## Abstract

This study aimed to examine the determinants that influence quality of life among older adults diagnosed with atrial fibrillation (AF) and to explore the direct and indirect pathways between these factors using structural equation modeling (SEM).

A convenience sample of 252 older adults with AF who were admitted to the hospital between August 2023 and August 2024 was included. Data were collected using the Atrial Fibrillation Effect on Quality-of-Life (AFEQT) questionnaire, Self-Rating Depression Scale (SDS), Self-Rating Anxiety Scale (SAS), and Social Support Rating Scale (SSRS). Patients were categorized into high-quality (n = 158) and low-quality (n = 94) groups according to theira AFEQT scores. Independent determinants were identified through univariate analysis and multivariate logistic regression, followed by the construction of an SEM model to assess interrelationships among variables.

Age, monthly income, AF type, New York Heart Association functional classification, treatment adherence, SDS score, SSRS score, and presence of comorbid chronic conditions were identified as independent determinants of quality of life (p < 0.05). SEM demonstrated that age, monthly income, AF type, SDS score, and SSRS score exerted both direct effects (path coefficients of 0.200, −0.131, 0.134, 0.160, and −0.207, respectively) and indirect effects through mediating variables, resulting in total effect coefficients of 0.316, −0.168, 0.188, 0.225, and −0.347, respectively.

Quality of life among older adults with AF was influenced by multiple interrelated factors. Social support, psychological status, and economic circumstances exerted significant combined effects through both direct and indirect pathways. The development of individualized, evidence-based nursing interventions that address these determinants may contribute to improved quality of life and overall health outcomes in this population.