The management of atrial fibrillation in heart failure: an expert panel consensus

Heart Fail Rev. 2021 Nov;26(6):1345-1358. doi: 10.1007/s10741-020-09978-0.

Abstract

Heart failure (HF) and atrial fibrillation (AF) often coexist, being closely interrelated as the one increases the prevalence and incidence and worsens the prognosis of the other. Their frequent coexistence raises several challenges, including under-diagnosis of HF with preserved ejection fraction in AF and of AF in HF, characterization and diagnosis of atrial cardiomyopathy, target and impact of rate control therapy on outcomes, optimal rhythm control strategy in the era of catheter ablation, HF-related thromboembolic risk and management of anticoagulation in patients with comorbidities, such as chronic kidney disease or transient renal function worsening, coronary artery disease or acute coronary syndromes, valvular or structural heart disease interventions and cancer. In the present document, derived by an expert panel meeting, we sought to focus on the above challenging issues, outlining the existing evidence and identifying gaps in knowledge that need to be addressed.

Keywords: Atrial fibrillation; Direct oral anticoagulants; Heart failure; Non-vitamin K antagonist oral anticoagulants; Rate control; Rhythm control.

Publication types

  • Review

MeSH terms

  • Anticoagulants / therapeutic use
  • Atrial Fibrillation* / complications
  • Atrial Fibrillation* / drug therapy
  • Atrial Fibrillation* / epidemiology
  • Consensus
  • Heart Failure* / epidemiology
  • Heart Failure* / therapy
  • Humans
  • Thromboembolism* / etiology
  • Thromboembolism* / prevention & control

Substances

  • Anticoagulants