Burden of Potentially Undiagnosed Heart Failure With Preserved Ejection Fraction in Atrial Fibrillation and Effects of Catheter Ablation: Insights From CABANA

Figures

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  Figure 1. Symptom burden in probable HFpEF with AF. The group with probable HFpEF included only a minority of patients with known HFpEF (17%), with most (83%) representing patients with dyspnea and high HFpEF probability without diagnosed HFpEF. Physician adjudicated NYHA class did not reflect patient reported symptom burden in patients with self‐reported dyspnea with nearly half having reported NYHA class I despite patient reported dyspnea on questionnaire (A). Patients with probable HFpEF had more symptoms of dyspnea and effort intolerance during ordinary activities consistent with probable undiagnosed HFpEF (B). We estimated that ∼93% of patients with AF, dyspnea, and no known HF in CABANA likely had undiagnosed HFpEF (C). This translated into 68% of the overall CABANA population with no known HF potentially having undiagnosed HFpEF. AF, indicates atrial fibrillation; CABANA, Catheter Ablation vs. Antiarrhythmic Drug Therapy; HFpEF, heart failure with preserved ejection fraction; and NYHA, New York Heart Association.

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  Figure 2. Differences in fatigue and inability to exercise by baseline HFpEF status in AF. Probable HFpEF was associated with worse frequency and severity of tiredness/lack of energy (A) and inability to exercise (B). Numbers represent percentages. AF indicates atrial fibrillation; and HFpEF, heart failure with preserved ejection fraction.

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  Figure 3. Effect of ablation on quality of life and symptom burden by baseline HFpEF probability status. Probable HFpEF was associated with worse symptoms and quality of life at baseline (as assessed by EQ5D [A] and MAFSI frequency [B] and severity [C]) and follow‐up but was associated with the greatest benefit from catheter ablation compared with medical therapy. EQ5D indicates EuroQol‐5 DimensionD‐3 Level; EuroQol, European Quality of Life; HFpEF, heart failure with preserved ejection fraction; and MAFSI, Mayo Atrial Fibrillation‐Specific Symptom Inventory.

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  Figure 4. Quantification of the average effect of ablation on quality of life and symptom burden by baseline HFpEF probability status across follow‐up. (A‐C) The magnitude of benefit of ablation was greatest on symptoms and quality of life for those with probable HFpEF at baseline compared with those without HFpEF. EQ5D indicates EuroQol‐5 DimensionD‐3 Level; EuroQol, European Quality of Life; HFpEF, heart failure with preserved ejection fraction; MAFSI, Mayo Atrial Fibrillation‐Specific Symptom Inventory; and treatment (Rx).