title: Atrial fibrillation in heart failure: what should we do?
abstract: Heart failure (HF) and atrial fibrillation (AF) are two conditions that are likely to dominate the next 50 years of cardiovascular (CV) care. Both are increasingly prevalent and associated with high morbidity, mortality, and healthcare cost. They are closely inter-related with similar risk factors and shared pathophysiology. Patients with concomitant HF and AF suffer from even worse symptoms and poorer prognosis, yet evidence-based evaluation and management of this group of patients is lacking. In this review, we evaluate the common mechanisms for the development of AF in HF patients and vice versa, focusing on the evidence for potential treatment strategies. Recent data have suggested that these patients may respond differently than those with HF or AF alone. These results highlight the clear clinical need to identify and treat according to best evidence, in order to prevent adverse outcomes and reduce the huge burden that HF and AF are expected to have on global healthcare systems in the future. We propose an easy-to-use clinical mnemonic to aid the initial management of newly discovered concomitant HF and AF, the CAN-TREAT HFrEF + AF algorithm (Cardioversion if compromised; Anticoagulation unless contraindication; Normalize fluid balance; Target initial heart rate <110 b.p.m.; Renin-angiotensin-aldosterone modification; Early consideration of rhythm control; Advanced HF therapies; Treatment of other CV disease).
authors.affiliation: Institute of Cardiovascular Science, University of Birmingham, Birmingham, UK Monash Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Australia d.kotecha@bham.ac.uk.
authors.forename: Dipak
authors.initials: D
authors.lastname: Kotecha
authors.affiliation: Duke Center for Atrial Fibrillation, Clinical Cardiac Electrophysiology, Duke University Medical Center, Durham, USA.
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Piccini
mesh_terms: D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000209:etiology* / Q000517:prevention & control / Q000628:therapy; D058409:Cardiac Resynchronization Therapy Devices; D009202:Cardiomyopathies / Q000209:etiology; D017115:Catheter Ablation / Q000379:methods; D004554:Electric Countershock / Q000379:methods; D005544:Forecasting; D006333:Heart Failure / Q000209:etiology* / Q000628:therapy; D006801:Humans; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D020521:Stroke / Q000517:prevention & control; D013318:Stroke Volume / Q000502:physiology
chemical_list: D000889:Anti-Arrhythmia Agents; D000925:Anticoagulants
keywords: Atrial fibrillation; Heart failure; Management; Review