Association between atrial fibrillation and heart failure patient reported outcomes across the ejection fraction spectrum

Khaled Elkholey; Zain Ul Abideen Asad; Esraa Shehata; Irina Mustafina; Marat Fudim; Stavros Stavrakis

doi:10.1016/j.ahj.2024.04.017

Association between atrial fibrillation and heart failure patient reported outcomes across the ejection fraction spectrum

Am Heart J. 2024 Apr 27:273:61-71. doi: 10.1016/j.ahj.2024.04.017. Online ahead of print.

Authors

Khaled Elkholey¹, Zain Ul Abideen Asad², Esraa Shehata³, Irina Mustafina², Marat Fudim⁴, Stavros Stavrakis⁵

Affiliations

¹ Department of Medicine, Centennial Medical Center, Nashville, TN.
² Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK.
³ Department of Cardiology, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK.
⁴ Division of Cardiology, Department of Medicine, Duke University, Durham, NC; Wroclaw University Medical Center, Division of Cardiology, Wroclaw Poland.
⁵ Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK. Electronic address: stavros-stavrakis@ouhsc.edu.

PMID: 38685463
DOI: 10.1016/j.ahj.2024.04.017

Abstract

Background: Atrial fibrillation (AF) is common in patients with heart failure (HF) and is associated with worse clinical outcomes. We evaluated the relationship between AF and longitudinal changes in health-related quality of life (HRQoL) measured by Kansas City Cardiomyopathy Questionnaire (KCCQ) in both HF with preserved (HFpEF) and reduced ejection fraction (HFrEF).

Methods: This is a post-hoc analysis of the TOPCAT and HF-ACTION trials. The effect of AF on KCCQ overall summary scores (OSS), in both trials, was examined using a mixed effects regression model. Patients were divided into 3 groups according to AF status at baseline: patients with a history of AF but no AF detected on ECG at enrollment (Hx AF group), patients with history of AF and AF detected on ECG at enrollment (ECG AF group) and patients with post-randomization new-onset AF (New AF group).

Results: In TOPCAT, among 1,710 patients with KCCQ data available, AF was associated with a significantly lower KCCQ-OSS (-3.98; 95% CI -7.21: -0.74) at 48 months, with a significant AF status by time interaction (P = .03). In HF-ACTION, among 1,814 patients with available KCCQ data, AF was associated with a significantly lower KCCQ-OSS (-3.67; 95% CI -6.21: -1.41) at 24 months but there was no significant AF status by time interaction. In both trials, the type of AF was not associated with significant changes in KCCQ-OSS score.

Conclusion: Ιn patients with both HFpEF and HFrEF, AF was independently associated with worse HRQoL measured by KCCQ.