Informal caregiving in patients with atrial fibrillation and multimorbidity: A cross-European study of caregiver burden, health-related quality of life, and caregiver engagement

Background: – Atrial fibrillation (AF), often accompanied by multimorbidity, places heavy demands on informal caregivers. Although caregiver burden is recognized in other chronic conditions, little is known about burden, health-related quality of life (HRQoL), and engagement among caregivers of patients with AF across Europe. Objectives: – The aim of the study was to examine caregiver burden, HRQoL, and engagement among informal caregivers of patients with AF and multimorbidity, and to explore interrelationships between these outcomes and caregiving characteristics. Methods: – A cross-sectional online survey was conducted between May 2022 and January 2023 with 179 informal caregivers from Italy, Romania, and Spain. Validated instruments assessed burden (Bakas Caregiving Outcomes Scale), HRQoL (EQ-5D-3L), and caregiver engagement (Caregiving Health Engagement Scale). Group differences were tested using nonparametric analyses, and associations were examined through partial Spearman correlations, adjusting for sociodemographic and caregiving variables. Results: – Participants reported moderate burden and preserved HRQoL in physical domains, but frequent pain/discomfort and anxiety/depression. Engagement was generally low, with most informal caregivers in early or intermediate stages of engagement. Burden was higher among women, younger caregivers, and those in Italy and Romania, while HRQoL was poorer in older caregivers, cohabitants, and those caring for patients with a higher number of comorbidities or reduced mobility. Highly engaged caregivers reported lower burden, better overall health, and less anxiety/depression than low-engaged peers. Conclusions: – Informal caregivers of patients with AF and multimorbidity face psychological strain despite preserved physical functioning. Engagement was a protective factor associated with a lower burden and improved well-being. Fostering engagement and collaboration with professionals may ease strain and support sustainability.