Health-related quality of life and mortality in patients with atrial fibrillation and the whole spectrum of heart failure: Insights from the HEart failuRe ObsErvational Study (HEROES)

BACKGROUND: There is a close association between atrial fibrillation (AF), heart failure (HF), and health-related quality of life (HRQoL). AIMS: We performed a comparative assessment of the HRQoL in patients with HF with preserved ejection fraction (HFpEF), HF with mildly reduced ejection fraction (HFmrEF), and HF with reduced ejection fraction (HFrEF), with and without AF, and their impact on prognosis. METHODS: Hospitalized patients and outpatients with HF were enrolled in the Heart Failure Observational Study (HEROES) from April 2, 2022, to March 27, 2024. The Kansas City Cardiomyopathy Questionnaire-12 Summary Score (KCCQ-12 SS) was used to assess HRQoL. Follow-up, which concluded on May 21, 2024, included all-cause mortality. RESULTS: The total study group consisted of 1199 patients. Patients without AF had a higher median KCCQ-12 SS, 56.3 (34.4-78.1) compared with those with AF, 42.2 (24.0-64.3), P <0.001. Among AF patients with HFpEF (n = 317; 26.4%), HFmrEF (n = 262; 21.9%), and HFrEF (n = 620; 51.7%), the adjusted hazard ratios for all-cause mortality (n = 180; 15%) for each 10-unit KCCQ-12 SS decrement were 1.22 (95% confidence interval [CI], 1.00-1.35; P = 0.07), 1.11 (95% CI, 0.91-1.35; P = 0.30), and 1.00 (95% CI, 0.82-1.11; P = 1.00), respectively. Among patients without AF with HFpEF, HFmrEF, and HFrEF, the corresponding adjusted hazard ratios were 1.63 (95% CI, 1.10-2.48; P = 0.005), 1.00 (95% CI, 0.83-1.22; P = 1.0), and 1.11 (95% CI, 1.00-1.22; P = 0.04), respectively. CONCLUSIONS: HRQoL was lower in patients with AF and HF compared to those without AF. A lower HRQoL score is an independent predictor of all-cause mortality in HF patients, particularly in those without AF (HFpEF and HFrEF subgroups), although associations varied by HF subtype and AF status.