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

Ravi B. Patel, Muthiah Vaduganathan, G. Michael Felker, Javed Butler, Margaret May Redfield, Sanjiv J. Shah

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)1660-1666
Number of pages7
JournalAmerican Journal of Cardiology
Volume123
Issue number10
DOIs
StatePublished - May 15 2019

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Atrial Flutter
Nitrates
Atrial Fibrillation
Heart Failure
Biomarkers
Quality of Life
Exercise
Brain Natriuretic Peptide
isosorbide-5-mononitrate
Natriuretic Peptides

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Physical Activity, Quality of Life, and Biomarkers in Atrial Fibrillation and Heart Failure With Preserved Ejection Fraction (from the NEAT-HFpEF Trial). / Patel, Ravi B.; Vaduganathan, Muthiah; Felker, G. Michael; Butler, Javed; Redfield, Margaret May; Shah, Sanjiv J.

In: American Journal of Cardiology, Vol. 123, No. 10, 15.05.2019, p. 1660-1666.

Research output: Contribution to journalArticle

Patel, Ravi B. ; Vaduganathan, Muthiah ; Felker, G. Michael ; Butler, Javed ; Redfield, Margaret May ; Shah, Sanjiv J. / Physical Activity, Quality of Life, and Biomarkers in Atrial Fibrillation and Heart Failure With Preserved Ejection Fraction (from the NEAT-HFpEF Trial). In: American Journal of Cardiology. 2019 ; Vol. 123, No. 10. pp. 1660-1666.
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