Atrial fibrillation and heart failure: intersecting populations, morbidities, and mortality

Heart failure (HF) and atrial fibrillation (AF) are the only two cardiovascular disorders that continue to increase in magnitude in the United States. The purpose of this brief overview is to provide a description of these two cardiovascular epidemics of HF and AF as they interact, and to provide additional information regarding the emerging influence of genetics and environment in the development of AF in the HF setting. These two modern epidemics are highly interactive and highly age-dependent. The development of new AF in a patient with either HF with preserved ejection fraction or HF with reduced ejection fraction possesses challenging management issues for practicing physicians. Control of heart rate is always prudent though still not precisely defined. The need to restore normal sinus rhythm is highly patient-dependent and strategies will vary. Elderly patients derive the most benefit from anticoagulation, but are also more prone to falls and bleeding complications. Today, we know much more about AF and HF and how they interact. The extent of AF/HF challenge is now widely recognized. It is inevitable that as people age, they will develop structural and functional changes in the cardiovascular system, some of which will predispose to the development of HF and AF. Not every case of HF or AF is preventable. Nevertheless, it is only throughout careful observations and further studies that we will be able to better manage these two Goliaths.