Atrial fibrillation and heart failure in cardiology practice: reciprocal impact and combined management from the perspective of atrial fibrillation: results of the Euro Heart Survey on atrial fibrillation.
OBJECTIVE
Our aim was to identify shortcomings in the management of patients with both atrial fibrillation (AF) and heart failure (HF).


BACKGROUND
AF and HF often coincide in cardiology practice, and they are known to worsen each other's prognosis, but little is known about the quality of care of this combination.


METHODS
In the observational Euro Heart Survey on AF, 5,333 AF patients were enrolled in 182 centers across 35 European Society of Cardiology member countries in 2003 and 2004. A follow-up survey was performed after 1 year.


RESULTS
At baseline, 1,816 patients (34%) had HF. Recommended therapy for HF with left ventricular systolic dysfunction (LVSD) with a beta-blocker and either an angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker was prescribed in 40% of HF patients, while 29% received the recommended drug therapy for both LVSD-HF and AF, consisting of the combination of a beta-blocker, either ACEI or angiotensin II receptor blocker, and oral anticoagulation. Rate control was insufficient with 40% of all HF patients with permanent AF having a heart rate < or =80 beats/min. In the total cohort, HF patients had a higher risk for mortality (9.5% vs. 3.3%; p < 0.001), (progression of) HF (24.8% vs. 5.0%; p < 0.001), and AF progression (35% vs. 19%; p < 0.001) during 1-year follow-up. Of all recommended drugs for AF and LVSD-HF, only ACEI prescription was associated with improved survival during 1-year follow-up (odds ratio: 0.51 [95% confidence interval: 0.31 to 0.85]; p = 0.011).


CONCLUSIONS
The prescription rate of guideline-recommended drug therapy for AF and LVSD-HF is low. Randomized controlled trials targeting this highly prevalent subgroup with AF and HF are warranted.
Nieuwlaat
Robby
R
Department of Cardiology, University Hospital Maastricht, Maastricht, The Netherlands. nieuwlaatrobby@live.com.au
Eurlings
Luc W
LW
Cleland
John G
JG
Cobbe
Stuart M
SM
Vardas
Panos E
PE
Capucci
Alessandro
A
López-Sendòn
José L
JL
Meeder
Joan G
JG
Pinto
Yigal M
YM
Crijns
Harry J G M
HJ
D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000503:physiopathology; D002309:Cardiology / Q000639:trends*; D016001:Confidence Intervals; D003324:Coronary Artery Disease / Q000188:drug therapy* / Q000503:physiopathology; D005060:Europe; D005260:Female; D006306:Health Surveys; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D017410:Practice Guidelines as Topic; D011379:Prognosis; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy
D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors