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

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 nonHFpEF 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.