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Atrial Fibrillation and Heart Failure With Reduced Ejection Fraction: New Assessment of an Old Problem
Emily P Zeitler1, Amber E Johnson2, Lauren B Cooper3
1Section of Cardiovascular Medicine, Dartmouth Health and The Dartmouth Institute, Lebanon New Hampshire, USA.
Insights
Atrial fibrillation (AF) and heart failure (HF) often coexist, worsening cardiovascular outcomes. Understanding their shared risk factors and mechanisms is key to developing new treatments and guidelines for managing these intertwined conditions.
Area of Science:
- Cardiology
- Clinical Medicine
- Translational Research
Background:
- Atrial fibrillation (AF) and heart failure (HF), particularly heart failure with reduced ejection fraction (HFrEF), frequently coexist.
- The interplay between AF and HFrEF is bidirectional, impacting mechanisms, clinical presentation, quality of life, and long-term outcomes.
- Shared risk factors for AF and HFrEF present opportunities for preventative strategies.
Purpose of the Study:
- To review the complex relationship between AF and HFrEF.
- To highlight updated multisociety guidelines for managing comorbid AF and HF.
- To provide context on clinical trial findings and evolving management recommendations.
Main Methods:
- Literature review focusing on the pathophysiology, risk factors, and clinical implications of coexisting AF and HFrEF.
- Analysis of recent clinical trial data relevant to this patient population.
- Synthesis of updated guideline recommendations.
Main Results:
- AF and HFrEF share overlapping risk factors and pathophysiological pathways.
- Management strategies are evolving, with updated guidelines incorporating specific recommendations for comorbid AF and HF.
- Clinical trials are providing new insights into effective interventions.
Conclusions:
- Effective management of patients with both AF and HFrEF requires a comprehensive approach addressing their intertwined nature.
- Understanding the shared mechanisms and risk factors is crucial for improving patient outcomes.
- Continued research and guideline updates are essential for optimizing care in this growing population.
Abstract:
Atrial fibrillation (AF) and heart failure (HF)-specifically, heart failure with reduced ejection fraction (HFrEF)-often coexist, and each contributes to the propagation of the other. This relationship extends from the mechanistic and physiological to clinical syndromes, quality of life, and long-term cardiovascular outcomes. The risk factors for AF and HF overlap and create a critical opportunity to prevent adverse outcomes among patients at greatest risk for either condition. Increasing recognition of the linkages between AF and HF have led to widespread interest in designing diagnostic, predictive, and interventional strategies targeting all aspects of disease, from identifying genetic predisposition to addressing social determinants of health. Advances across this spectrum culminated in updated multisociety guidelines for management of AF, which includes specific consideration of comorbid AF and HF. This review expands on these guidelines by further highlighting relevant clinical trial findings and providing additional context for the evolving recommendations for management in this important and growing population.
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