Abstract
Introduction: Atrial fibrillation (AF) and heart failure (HF) both significantly impact morbidity and mortality, and also account for impaired quality of life. Patient-reported outcomes represent the most direct measurement of quality of life, without influence of interpretation by the clinician. We sought to evaluate the effect of AF on patient-reported outcomes using the Kansas City Cardiomyopathy Questionnaire (KCCQ) in patients with HF with preserved ejection fraction (HFpEF) enrolled in TOPCAT trial. Methods: This was an exploratory post-hoc analysis of the TOPCAT trial. Patients with reported KCCQ at randomization were included in this analysis. KCCQ was collected at randomization, 4, 12, 24, 36, 48, and 72 months. Mixed model repeated measure ANOVA was used to explore the effect of AF status at the time of randomization on longitudinal changes in the KCCQ- overall symptom score (OSS) over the duration of follow-up. Covariates adjusted for included age, gender, race, diabetes mellitus, history of HF hospitalization and use of ACEIs or ARBs. Results: A total of 3403 patients (mean age 68.5±9.5 years, females 51.5%) with available KCCQ-OSS at baseline were included. AF was prevalent in 1202 (35.3%) patients at baseline (mean age 71.0±9.3, 46.3% women, 91.7% white). AF patients had higher prevalence of stroke, diabetes mellitus, hypertension and lower prevalence of HF hospitalization. Over the duration of follow-up, there was a significant time by AF status interaction (p<0.001), suggesting that KCC-OSS changed differently overtime based on the AF status. Conclusions: Among patients with HFpEF from TOPCAT cohort, prevalent AF at baseline was associated with lower quality of life and lower KCCQ-OSS over 5 years of follow-up, suggested by the significant interaction between AF status and time of follow-up.
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