Quantifying the Impact of Atrial Fibrillation on HF-Related Patient-Reported Outcomes in the Utah mEVAL Program.

BACKGROUND: Atrial fibrillation frequently complicates HF, and each is associated with lower overall HRQoL. We aimed to quantify the incremental burden of AF on the health-related quality of life of HF patients in clinical practice.

METHODS: We used data from the Utah mEVAL program to analyze patient-reported outcomes (PROs) among HF patients with and without AF. The primary outcome was the HF-specific Kansas City Cardiomyopathy Questionnaire (KCCQ), with generic PROs as secondary outcomes.

RESULTS: Among 1,707 patients with HF, 36% had AF (n=616). Those with HF and AF were older (mean age 69 vs. 58, p<0.001), more likely to have prior stroke (29% vs. 17 %, p<0.001) and ischemic cardiomyopathy (28% vs. 23%, p=0.01), but had similar ejection fractions (mean 44% each, p=0.6). After adjustment, and compared with HF alone, HF with AF was associated with worse KCCQ scores (adjusted mean difference -3.45, 95% CI -6.24 - -0.65), and worse PROMIS physical function scores (adjusted mean difference -1.63, 95% CI -2.59 - -0.67). Difference in VAS general health was borderline (adjusted mean difference -2.01, 95% CI -4.51 - 0.49), and PROMIS depression scores were similar (adjusted mean difference 0.54, 95% CI -0.48 - 1.57).

CONCLUSIONS: AF complicates nearly one-third of HF cases, and patients with HF and AF are substantially older and sicker. After adjustment, AF was independently associated with worse disease-specific and overall HRQoL than HF alone. Whether maintaining sinus rhythm can improve the HF-related health status of patients with HF in clinical practice should be further explored.