54Treating underlying conditions improves quality of life in patients with persistent atrial fibrillation and heart failure - data from the RACE 3 study

Abstract

Introduction: Atrial fibrillation (AF) reduces quality of life (QoL). Purpose: We sought to evaluate the effect of treating underlying conditions on QoL in patients with early persistent AF and early mild to moderate heart failure (HF). Methods: We studied QoL in 230 patients with early‐persistent AF and early mild to moderate HF included in the randomized, multicenter, prospective Routine versus Aggressive Risk Factor Driven Upstream Rhythm Control for Prevention of Early Atrial Fibrillation in Heart Failure (RACE 3) study. The intervention group received 4 therapies on top of conventional care: 1) mineralocorticoid receptor antagonists, 2) statins, 3) angiotensin converting enzyme inhibitors and/or receptor blockers, and 4) cardiac rehabilitation including physical activity, dietary restrictions, and counseling. The 36‐Item Short Form Health Survey (SF‐36), Toronto AF severity scale (AFSS) and EHRA class were used to assess QoL and AF related symptoms on baseline and 1 year follow up (FU). Analyses were performed on an intention to treat basis. Results: Age was 6569 years, 180 (78%) were men, median AF history was 3 (2‐6) months and median HF duration 2 (1‐4) was months. Hypertension was present in 139 (60%), diabetes in 22 (10%), coronary artery disease in 30 (13%). Left ventricular ejection fraction (LVEF) was 52 (43‐60)%, atrial volume 38 (31‐48) ml/m2. At baseline clinical characteristics were comparable in the intervention (n=114) and conventional group (n=116). At baseline the 8 SF‐36 domains were comparable between both groups. At 1‐year FU, all 8 SF‐36 categories improved in the intervention, compared to 4 out of 8 categories in the conventional group. Mean change between baseline and 1 year in physical functioning (D11.6619.2 vs D5.8622.5, p=0.015), physical role limitations (D32.8641.5 vs 16.5645.0, p=0.011), and general health (D8.3616.1 vs D‐0.3 617.2, p<0.001) was significantly higher in the upstream group. No differences in AFSS were present at baseline between groups. In the AFSS, dyspnea in rest improved significantly more in the intervention group (D‐0.861.3 vs D‐0.461.2, p=0.018). At baseline EHRA class was 2.0160.51 in the intervention vs 2.0560.51 (p=0.520) in the conventional group, and 1.3160.52 vs 1.5460.64 (p=0.003) at 1 year FU. Conclusion: A strategy aiming to treat underlying conditions improves physical functioning, physical role limitations and general health significantly more compared to conventional therapy in patients with persistent atrial fibrillation and mild to moderate heart failure.