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Screening for Unrecognized HFpEF in Atrial Fibrillation and for Unrecognized Atrial Fibrillation in HFpEF
Yogesh N V Reddy1, Peter Noseworthy1, Barry A Borlaug1
1Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA.
Insights
Screening for atrial fibrillation (AF) in heart failure with preserved ejection fraction (HFpEF) patients, and vice versa, is crucial. Early detection of these conditions can guide tailored therapies and improve patient outcomes.
Area of Science:
- Cardiology
- Internal Medicine
Background:
- Atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF) share a bidirectional relationship.
- Patients with one condition often have undiagnosed presence of the other, impacting management and prognosis.
Purpose of the Study:
- To review the evidence and rationale for screening for occult HFpEF in patients with AF.
- To review the evidence and rationale for screening for occult AF in patients with HFpEF.
Main Methods:
- Literature review summarizing current evidence and clinical rationale.
- Discussion of diagnostic approaches and therapeutic implications.
Main Results:
- Screening for HFpEF in AF patients may identify candidates for specific therapies via tests like exercise right heart catheterization.
- Screening for AF in HFpEF patients can identify occult AF, informing anticoagulation decisions and potentially guiding rhythm control strategies.
Conclusions:
- Screening facilitates understanding of overlapping symptoms and their underlying causes.
- Proactive screening can guide treatment to slow disease progression and reduce complications in patients with AF and HFpEF.
Abstract:
Because of the bidirectional relationship between atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF), individuals with either condition require consideration of screening for the other. In this review, we summarize current evidence and rationale for screening for occult HFpEF in adults with clinical AF; and occult AF in patients with clinically recognized HFpEF. Assessment of pretest probability for occult HFpEF in symptomatic AF patients may help guide additional testing such as exercise right heart catheterization to diagnose HFpEF and guide HFpEF-specific therapies. In patients with HFpEF, AF screening will identify cases of occult AF where anticoagulation may decrease stroke risk, and correlation of previously unknown AF episodes with paroxysmal symptoms may prompt consideration for rhythm control. Therefore, screening may help clinicians understand the etiology of the often-overlapping symptoms, and it may help guide treatments to slow progression of both conditions and their complications.
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