Abstract 14294: Effect of Atrial Fibrillation on Patient-Reported Outcomes in Heart Failure With Reduced Ejection Fraction: Secondary Analysis of Efficacy and Safety of Exercise Training in Patients With Chronic Heart Failure: HF-ACTION Trial

Abstract

Background: 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 reduced ejection fraction (HFrEF) enrolled in HF-ACTION trial. Methods: This was an exploratory post-hoc analysis of the HF-ACTION trial. Patients with reported KCCQ at randomization were included in this analysis. KCCQ was collected at randomization, 3, 6, 9, 12, 24, 36 months. Mixed effects regression modeling 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, BMI, sex, race, ejection fraction (EF), NYHA class, HF etiology, smoking, revascularization, MI, and use of Beta blockers, Digoxin, Diuretics, or ACEIs/ARBs. Results: A total of 2129 patients (mean age 58.5±12.6 years, males 71.9%) with available KCCQ-OSS at baseline were included and AF was prevalent in 443 (20.8%) patients. AF patients were more likely to be older white males and had lower BMI; with higher prevalence of NYHA classes III/IV, prior MI, revascularization, and ischemic etiology for HF. AF Patients had significantly lower KCCQ-OSS at 3 years (59.9±22 vs. 67.6±19.9, p= 0.002) compared to those without AF. There was a significant time by AF status interaction (p=0.045), suggesting that KCC-OSS changed differently overtime based on the AF status. Conclusion: Among patients with HFrEF from HF-ACTION trial, prevalent AF at baseline was associated with lower quality of life and lower KCCQ-OSS over 3 years of follow-up, suggested by the significant interaction between AF status and time of follow-up.