Atrial Fibrillation and Heart Failure: Synergistic Effect on Functional Class and Quality of Life

Background

Atrial fibrillation (AF) and heart failure (HF) are highly prevalent conditions associated with significant morbidity and symptom burden.

Hypothesis

This study compared the evolution over time of functional class and quality of life (QoL) in patients with HF according to the presence of AF.

Methods

A retrospective cohort study was conducted at an outpatient heart failure clinic in Colombia, between 2020 and 2022. Functional class (based on the New York Heart Association classification) and QoL (measured by the Minnesota Living with Heart Failure Questionnaire), were analyzed at baseline, 3 months, 6 months, and the last visit. The simultaneous impact of AF and left ventricular ejection fraction was analyzed using a generalized estimation equation model.

Results

Among the 440 patients (median age 74 years, 56.6% men), 41.4% with AF, and 65.2% with reduced ejection fraction (HFrEF). Over time, functional class improved in both groups, with a more significant improvement in patients without AF. Patients with AF and HFrEF were more likely to remain in worse functional classes (OR: 2.77; 95% CI: 1.37–5.62). Similar trends were observed in QoL questionnaire, with sustained improvement after 3 months. However, AF negatively affected the physical dimension in patients with HFrEF, increasing the QoL questionnaire score by up to 4%.

Conclusions

The presence of AF and reduced ejection fraction was associated with a lesser improvement in functional class and physical dimension of QoL questionnaire, emphasizing the importance of early detection and management of AF as part of comprehensive HF care.