Physical Activity, Quality of Life, and Biomarkers in Atrial Fibrillation and Heart Failure With Preserved Ejection Fraction (from the NEAT-HFpEF Trial).

Pubmed ID: 30876658

Pubmed Central ID: PMC6488421

Journal: The American journal of cardiology

Publication Date: May 15, 2019

Link: https://www.sciencedirect.com/science/article/pii/S0002914919302309?via%3Dihub

MeSH Terms: Humans, Male, Female, Aged, Aged, 80 and over, Middle Aged, Atrial Fibrillation, Heart Failure, Prognosis, Follow-Up Studies, Quality of Life, Stroke Volume, Double-Blind Method, Exercise, Peptide Fragments, Natriuretic Peptide, Brain, Exercise Tolerance, Protein Precursors, Biomarkers, Cross-Over Studies, Accelerometry, Isosorbide Dinitrate

Grants: T32 HL069771, U10 HL084904, U10 HL110336, U10 HL110309, U10 HL110338, U10 HL110262, U10 HL110302, U10 HL110312, U10 HL110342, U10 HL110337, UL1 TR002548, U54 GM115428, U10 HL110297

Authors: Butler J, Felker GM, Vaduganathan M, Redfield MM, Shah SJ, Patel RB

Cite As: Patel RB, Vaduganathan M, Felker GM, Butler J, Redfield MM, Shah SJ. Physical Activity, Quality of Life, and Biomarkers in Atrial Fibrillation and Heart Failure With Preserved Ejection Fraction (from the NEAT-HFpEF Trial). Am J Cardiol 2019 May 15;123(10):1660-1666. Epub 2019 Feb 23.

Studies:

Abstract

Although atrial fibrillation/atrial flutter (AF/AFL) and heart failure with preserved ejection fraction (HFpEF) frequently coexist, the influence of AF/AFL on physical activity, N-terminal pro-B-type natriuretic peptide (NT-proBNP), and quality of life in HFpEF is unclear and could have relevance to HFpEF trial design. We evaluated the association between AF/AFL and volitional physical activity, functional performance, NT-proBNP, and quality of life in patients with HFpEF in the Nitrate's Effect on Activity Tolerance (NEAT)-HFpEF trial. Of 99 patients with accelerometer data, 35 (35%) had AF/AFL. There were no differences between AF/AFL versus no AF/AFL in baseline average daily accelerometer units (ADAUs; 9.06 ± 0.54 vs 9.06 ± 0.48, p = 0.75), hours active per day (9.7 ± 2.3 vs 9.2 ± 2.2, p = 0.86), or 6-minute walk distance (6MWD; 307 ± 136m vs 321 ± 110m, p = 0.85). AF/AFL status was associated with higher baseline NT-proBNP (586 [25th to 75th percentile: 291 to 1254] pg/ml vs 154 [25th to 75th percentile: 92 to 288] pg/ml, p <0.001) and Kansas City Cardiomyopathy Questionnaire scores (69 [25th to 75th percentile: 46 to 88] vs 48 [25th to 75th percentile: 37 to 70], p = 0.01). Although treatment responses to isosorbide mononitrate measured by change in ADAUs, hours active per day, or 6MWD did not vary by AF/AFL status (interaction p >0.05 for all), AF/AFL patients had greater reductions in NT-proBNP after isosorbide mononitrate than patients without AF/AFL (interaction p <0.001), possibly due to regression to the mean. In conclusion, baseline measures and treatment-related changes in volitional physical activity (ADAUs) and functional performance (6MWD) did not differ by AF/AFL in NEAT-HFpEF, whereas NT-proBNP did. In HFpEF-where AF/AFL prevalence is high-functional measures may be superior to natriuretic peptides as trial endpoints.