Implications of Atrial Fibrillation for Guideline-Directed Therapy in Patients With Heart Failure: JACC State-of-the-Art Review (JACC March 2024-1)-Article: Implications of Atrial Fibrillation for Guideline-Directed Therapy in Patients With Heart Failure: JACC State-of-the-Art Review

Article: Implications of Atrial Fibrillation for Guideline-Directed Therapy in Patients With Heart Failure: JACC State-of-the-Art Review

Back to course

Pdf Summary

Atrial fibrillation (AF) and heart failure (HF) commonly coexist and worsen patient outcomes. Guideline-directed medical therapy (GDMT) for HF impacts the development and management of AF. Medications like angiotensin-converting enzyme inhibitors and angiotensin receptor blockers can prevent AF in HF patients. Beta-blockers are recommended for rate control in AF and may prevent AF occurrence. Angiotensin-neprilysin inhibitors like sacubitril/valsartan are being studied in AF and HF. More research is needed to determine the benefits of GDMT across different left ventricular ejection fractions. Managing both conditions together is vital for patient well-being. <br /><br />In HF patients, AF complicates the condition leading to worse outcomes. GDMT plays a crucial role in treating both AF and HF. Medications like ARNIs, beta-blockers, and MRAs reduce mortality and hospitalizations in patients with HF, irrespective of AF. While the benefits of beta-blockers in HF with AF are uncertain, ARNIs have shown a reduction in incident AF. Rhythm control strategies like catheter ablation benefit AF patients with HF, especially with reduced ejection fraction. Specific drug combinations and treatments have shown efficacy in reducing AF incidences and improving outcomes in HF patients. Proper management involves optimizing GDMT and possibly incorporating rhythm control strategies. Research is ongoing to further understand the effectiveness of various treatments for AF in the presence of HF.

Keywords

Atrial fibrillation

Heart failure

Guideline-directed medical therapy

Angiotensin-converting enzyme inhibitors

Angiotensin receptor blockers

Beta-blockers

Angiotensin-neprilysin inhibitors

Sacubitril/valsartan

Left ventricular ejection fraction

Catheter ablation