Existing non-invasive screening tools may miss heart failure in patients with atrial fibrillation (AF) and should be used with caution, according to recent research from the University of Adelaide (UA).
The warning follows a study by UA researchers examining the effectiveness of internationally recommended screening tools for diagnosing a specific condition called heart failure with preserved ejection fraction in atrial fibrillation patients.
“Diagnosing this type of heart failure in atrial fibrillation patients is particularly challenging because the symptoms of both diseases are very similar and can be overlooked to the detriment of the patient’s long-term treatment,” said lead author Dr. Jonathan Ariyaratnam, a postdoctoral fellow with the Center for Cardiac Arrhythmias, UA.
Atrial fibrillation causes the heart to beat irregularly and faster than normal, increasing the risk of blood clots in the heart. It can lead to life-threatening illnesses such as stroke and heart failure, the latter of which is said to affect 64 million people worldwide.
A previous study from the Center for Heart Rhythm Disorders used an invasive testing protocol to find that nearly 75% of patients with symptomatic atrial fibrillation had features of heart failure.
The most recent clinical trial, conducted between 2020 and 2022 at the Cardiac Arrhythmia Center, involved 120 atrial fibrillation patients undergoing ablation procedures.
The first screening tool was the HFA-PEFF score, which uses a diagnostic algorithm based on a resting echocardiogram, stress tests and blood markers to estimate a patient’s likelihood of heart failure.
The second screening tool was H²FPEF, which uses cardiovascular risk factors and resting echocardiographic parameters to predict the patient’s likelihood of heart failure. Both methods were compared to the current gold standard diagnostic tool, which is more invasive and requires direct access to the heart via special catheters.
“We found that the first screening tool was less likely to detect heart failure in younger, obese men with atrial fibrillation. The second method was more sensitive, but atrial fibrillation patients who showed early signs of heart failure were missed,” said senior author Dr. Adrian Elliott from the UA Center for Heart Rhythm Disorders and the Royal Adelaide Hospital.
“While the less invasive testing methods were able to diagnose heart failure in atrial fibrillation patients with moderate accuracy, invasive testing is still required to confirm the results and remains the best diagnostic tool.” On this basis, I would recommend these scoring systems in atrial fibrillation patients “use with caution,” said Prash Sanders, senior co-author, UA professor, director of the Cardiac Arrhythmias Center and director of cardiac electrophysiology and pacing at the Royal Adelaide Hospital.
The results of the study, titled “Usefulness and validity of HFA-PEFF and H2FPEF scores in patients with symptomatic atrial fibrillation,” were published in the journal JACC: Heart failure.