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Utility of Post-Procedural HFA-PEFF Reassessment for Long-Term Heart Failure Risk Stratification After Atrial
Hironori Ishiguchi1, Yasuhiro Yoshiga1, Masakazu Fukuda1
1Division of Cardiology, Department of Medicine and Clinical Science Yamaguchi University Graduate School of Medicine Ube Japan.
Insights
Post-procedural Heart Failure Audit-Performance, Evaluation, and Follow-up (HFA-PEFF) scores improve long-term heart failure risk prediction after atrial fibrillation ablation. This reassessment is especially valuable for patients with high baseline HFA-PEFF scores.
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure Management
Background:
- The role of post-procedural Heart Failure Audit-Performance, Evaluation, and Follow-up (HFA-PEFF) scoring for long-term heart failure (HF) risk stratification following atrial fibrillation (AF) ablation is not well-established.
- Atrial fibrillation ablation is a common procedure, and optimizing risk stratification for HF post-ablation is crucial for patient outcomes.
Purpose of the Study:
- To evaluate the utility of pre-procedural and post-procedural HFA-PEFF scores in predicting long-term HF hospitalization after AF ablation in patients with preserved ejection fraction.
- To compare the risk stratification performance of post-procedural HFA-PEFF reassessment against pre-procedural scores.
Main Methods:
- A retrospective cohort study involving 856 patients with preserved left ventricular ejection fraction (≥50%) undergoing AF ablation.
- HFA-PEFF scores were assessed before and after ablation (median 91 days post-ablation).
- HF hospitalization rates were compared across risk strata (low, intermediate, high) for both scores, with discrimination assessed using time-dependent ROC analysis at 2-5 years.
Main Results:
- The HFA-PEFF score significantly decreased post-ablation (median 3 to 2, p < 0.001), primarily due to changes in biomarkers.
- Post-procedural HFA-PEFF demonstrated superior discrimination for HF hospitalization compared to the pre-procedural score, particularly at 5 years (AUC 0.791 vs 0.686).
- Improved discrimination was noted in high-risk patients when assessing changes in HFA-PEFF scores.
Conclusions:
- Post-procedural HFA-PEFF reassessment offers added value for long-term HF hospitalization risk stratification in patients with preserved ejection fraction undergoing AF ablation.
- The benefit of reassessment is particularly pronounced in patients identified as high-risk by their baseline HFA-PEFF scores.
Background:
The utility of post-procedural HFA-PEFF reassessment for long-term heart failure (HF) risk stratification after atrial fibrillation (AF) ablation remains uncertain.
Methods:
In this single-center retrospective cohort study, we evaluated pre-procedural and post-procedural HFA-PEFF scores in 856 patients with preserved left ventricular ejection fraction (≥ 50%) undergoing index AF ablation. HF hospitalization from 1 year after ablation was compared across risk strata (low, 0-1; intermediate, 2-4; high, 5-6 points) for both scores. Discrimination was assessed using time-dependent receiver operating characteristic analysis at 2-5 years.
Results:
Post-procedural HFA-PEFF was assessed at a median of 91 (interquartile range, 87-97) days after ablation, and 92.8% of reassessments were obtained during sinus rhythm or atrial pacing. The HFA-PEFF score decreased significantly from 3 (2-4) to 2 (1-4) (p < 0.001), driven primarily by changes in the biomarker domain. During a median follow-up of 5.2 (3.5-7.6) years, 34 patients (4.0%) had HF hospitalization. Post-procedural HFA-PEFF showed higher discrimination than the pre-procedural score, especially at 5 years (area under the curve [95% confidence interval], 0.791 [0.686-0.896] versus 0.686 [0.562-0.809]; p = 0.028). In subgroup analyses, discrimination for change-based HFA-PEFF improvement (Δ ≤ -1 versus Δ ≥ 0) was greater in the baseline high-risk stratum (0.784 [0.635-0.934]) than in the low/intermediate-risk stratum (0.647 [0.546-0.748]).
Conclusions:
In patients with preserved left ventricular ejection fraction undergoing AF ablation, post-procedural HFA-PEFF reassessment may add value for long-term HF hospitalization risk stratification, particularly in those with high baseline HFA-PEFF scores.
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