Abstract 10057: Subclinical Atrial Fibrillation is More Prevalent in Heart Failure with Preserved Ejection Fraction Compared to the General Population

Abstract

Introduction: Atrial fibrillation (AF) is a common in patients with heart failure with preserved ejection fraction (HFpEF), and is associated with higher filling pressures, reduced exercise capacity, and reduced survival. The prevalence of subclinical AF in HFpEF remains unknown. Hypothesis: We hypothesized that subclinical AF was more prevalent in individuals with HFpEF when compared to individuals without clinical heart failure history. Methods: We evaluated subclinical AF in 101 HFpEF patients with no prior diagnosis of clinical AF using 14 day ambulatory ECG patch monitoring (Ziopatch XT, iRhythm Technologies). We compared the prevalence of subclinical AF in HFpEF with controls drawn from 3303 participants in the Multi-Ethnic Study of Atherosclerosis (MESA) exam 6 follow-up, excluding those with known heart failure or high H2FpEF score who underwent the same ECG patch monitoring. Case-control comparisons of participants between the ages of 55 to 93 years were performed using multivariable logistic regression to adjust for demographic and clinical comorbidities, as well as patch monitoring duration. Results: 80 HFpEF patients and 1356 MESA participants were included. The HFpEF patients were younger (69 [63, 76] v. 72 [66, 80], p=0.02), more obese (BMI of 36 [30, 45] v. 27 [24, 30], p<0.001) and more likely to have diabetes (34 v. 21%, p=0.01). There was a higher proportion of African Americans in the HFpEF group (57.5 v. 22.8%, p<0.001). The prevalence of subclinical AF was 9.8% in HFpEF group and 6.2% in MESA participants. After multivariable adjustment for age, sex, race, body mass index, hypertension, diabetes, smoking pack-years and total analyzable time on ECG monitor there was a significantly higher odds of subclinical AF in HFpEF compared to MESA (OR 4.26 [1.2, 16.2], p=0.03). Conclusions: HFpEF patients have a higher prevalence of subclinical AF than the general population. Screening for atrial arrhythmias may be appropriate in HFpEF patients for timely initiation of thromboembolic prophylaxis, and may identify individuals at greater risk for clinical decompensation in light of the well documented risks associated with AF in HFpEF.