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. 2024 Jan 18;11(1):e002526.
doi: 10.1136/openhrt-2023-002526.

Association of HFA-PEFF score with clinical outcomes after catheter ablation for atrial fibrillation

Taiji Okada  1 , Takeshi Kitai  2 , Atsushi Kobori  3 , Madoka Sano  4 , Ryosuke Murai  4 , Toshiaki Toyota  4 , Yasuhiro Sasaki  4 , Tomohiko Taniguchi  5   6 , Kitae Kim  4 , Natsuhiko Ehara  3 , Makoto Kinoshita  4 , Yutaka Furukawa  4
Affiliations

Association of HFA-PEFF score with clinical outcomes after catheter ablation for atrial fibrillation

Taiji Okada et al. Open Heart. .

Abstract

Background: The Heart Failure Association Pretest assessment, echocardiography and natriuretic peptide, functional testing and final aetiology (HFA-PEFF) score has been developed for diagnosing heart failure with preserved ejection fraction (HFpEF), which is frequently associated with atrial fibrillation (AF). We aimed to investigate whether preprocedural HFA-PEFF score could be used to predict clinical outcomes in patients with AF who underwent catheter ablation (CA).

Methods: Overall, 1679 patients with AF who underwent primary CA (71±10 years, 1218 males (72.5%), median follow-up duration 3.3 years) from July 2011 to December 2019 were included in this retrospective study. HFpEF was defined as an HFA-PEFF score ≥5. The primary study outcome was 5-year major adverse cardiovascular and cerebrovascular events (MACCE), which is a composite of all-cause death, hospitalisation for heart failure (HF) and hospitalisation for stroke.

Results: The prevalence of HFpEF was 32.3%, but only 7.7% were diagnosed with HF at the time of CHADS2 scoring. Five-year MACCE occurred in 77 patients (4.6%). The cumulative 5-year incidence of MACCE was significantly higher in the HFpEF group than in the non-HFpEF group (11.2% vs 4.8% at 5 years, p<0.001). In the multivariable analysis, HFpEF by the HFA-PEFF score was associated with MACCE (adjusted HR 1.65, 95% CI 1.02 to 2.65, p=0.041).

Conclusions: Early detection of HFpEF using the HFA-PEFF score may have clinical applications in guiding therapeutic decision-making and improving prognosis by preventing HF and stroke in patients with AF undergoing CA.

Keywords: atrial fibrillation; catheter ablation; heart failure, diastolic.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Flow chart illustrating the study population. Overall, 2123 patients with AF who underwent primary ablation were screened, and finally, 1679 patients were analysed retrospectively in this study. The circles in the diagram represent the percentage of heart failure with preserved left ventricular ejection fraction at each score. AF, atrial fibrillation; HFA-PEFF, Heart Failure Association Pretest assessment, echocardiography and natriuretic peptide, functional testing and final aetiology; HFpEF, heart failure preserved left ventricular ejection fraction; LVEF, left ventricular ejection fraction.
Figure 2
Figure 2
Kaplan-Meier analyses show the cumulative rate of the primary composite end point (A), all-cause death (B), hospitalisation for HF (C) and hospitalisation for stroke (D) stratified by the Heart Failure Association Pretest assessment, echocardiography and natriuretic peptide, functional testing and final aetiology score. HFpEF, heart failure preserved left ventricular ejection fraction.
Figure 3
Figure 3
Kaplan-Meier analyses show the cumulative rate of the primary composite end point stratified by the HFA-PEFF score in the subgroup of patients with paroxysmal AF (A), persistent AF (B), AF recurrence (C) and AF no recurrence (D). AF, atrial fibrillation; HFA-PEFF, Heart Failure Association Pretest assessment, echocardiography and natriuretic peptide, functional testing and final aetiology; HFpEF, heart failure preserved left ventricular ejection fraction.
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