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J Am Coll Cardiol. 2009 May 5;53(18):1690-8. doi: 10.1016/j.jacc.2009.01.055.

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.

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1
Department of Cardiology, University Hospital Maastricht, Maastricht, The Netherlands. nieuwlaatrobby@live.com.au

Abstract

OBJECTIVES:

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.

PMID:
19406345
DOI:
10.1016/j.jacc.2009.01.055
[Indexed for MEDLINE]
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