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Review
. 2022 Nov 18:8:e32.
doi: 10.15420/cfr.2022.03. eCollection 2022 Jan.

Breaking the Cycle of Heart Failure With Preserved Ejection Fraction and Atrial Fibrillation

Otilia Ţica  1   2 , Waseem Khamboo  1 , Dipak Kotecha  1   3
Affiliations
Review

Breaking the Cycle of Heart Failure With Preserved Ejection Fraction and Atrial Fibrillation

Otilia Ţica et al. Card Fail Rev. .

Abstract

Heart failure with preserved ejection fraction (HFpEF) and AF are two common cardiovascular conditions that are inextricably linked to each other's development and progression, often in multimorbid patients. Current management is often directed to specific components of each disease without considering their joint impact on diagnosis, treatment and prognosis. The result for patients is suboptimal on all three levels, restricting clinicians from preventing major adverse events, including death, which occurs in 20% of patients at 2 years and in 45% at 4 years. New trial evidence and reanalysis of prior trials are providing a glimmer of hope that adverse outcomes can be reduced in those with concurrent HFpEF and AF. This will require a restructuring of care to integrate heart failure and AF teams, alongside those that manage comorbidities. Parallel commencement and non-sequential uptitration of therapeutics across different domains will be vital to ensure that all patients benefit at a personal level, based on their own needs and priorities.

Keywords: AF; Heart failure; comorbidities; heart failure with preserved ejection fraction; management; treatment.

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Conflict of interest statement

Disclosure: DK reports grants from the National Institute for Health Research (NIHR CDF-2015-08-074 RATE-AF, NIHR130280 DaRe2THINK, NIHR132974 D2T-NeuroVascular), the British Heart Foundation (PG/17/55/33087, AA/18/2/34218, FS/CDRF/21/21032), the European Union/European Federation of Pharmaceutical Industries and Associations Innovative Medicines Initiative (BigData@Heart 116074), the European Society of Cardiology supported by educational grants from Boehringer Ingelheim/BMS-Pfizer Alliance, Bayer, Daiichi Sanyko, Boston Scientific, the NIHR/University of Oxford Biomedical Research Centre and the British Heart Foundation/University of Birmingham Accelerator Award (STEEER-AF NCT04396418), Amomed Pharma and IRCCS San Raffaele/Menarini (Beta-blockers in Heart Failure Collaborative Group NCT0083244), as well as advisory board personal fees from Bayer, Amomed, Protherics Medicines Development and Myokardia (all outside the submitted work). DK is an editorial board member for Cardiac Failure Review; this did not influence peer review. OT reports funding from EU/EEPIA Innovative Medicines Initiative (BigData@Heart 116074) and Amomed Pharma outside the submitted work. WK has no conflicts of interest to declare.

Figures

Figure 1:
Figure 1:. Mechanisms and Inter-relationship of Heart Failure With Preserved Ejection Fraction and AF
Figure 2:
Figure 2:. All-cause Mortality in Patients with Heart Failure With Preserved Ejection Fraction and AF
Figure 3:
Figure 3:. Update to the CAN-TREAT Management Paradigm in Patients with AF and Heart Failure
See this image and copyright information in PMC

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