The burden of atrial fibrillation in patients with preserved or mildly reduced heart failure: a call to action for detecting atrial fibrillation and improving outcome

Boriani, Giuseppe; Imberti, Jacopo Francesco; Vitolo, Marco

doi:10.1002/ejhf.2755

Cited by 6 publications

(4 citation statements)

References 22 publications

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“…Present findings are in accordance with previous investigations, always on the basis of the CDC WONDER data set, that separately assessed the HF‐ 13 and AF‐ 14 related mortality rates and their trends in the United States over the past 2 decades. Although our findings cannot confer causation, several previous analyses have shown a pathophysiological association between AF and HF and vice versa, 25 , 26 , 27 , 28 , 29 which increases the mortality risk across all HF subtypes. 30 A variety of explanations may support the observed trends.…”

Section: Discussioncontrasting

confidence: 52%

Heart Failure–Related Death in Subjects With Atrial Fibrillation in the United States, 1999 to 2020

Zuin,

Bertini,

Vitali

et al. 2024

JAHA

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Background Population‐based data on heart failure (HF)‐related death in patients with atrial fibrillation (AF) are lacking. We assessed HF‐related death in people with AF in the United States over the past 21 years and examined differences by age, sex, race, ethnicity, urbanization, and census region. Methods and Results Data were extracted from the Centers for Disease Control and Prevention Wide‐Ranging Online Data for Epidemiologic Research to determine trends in age‐adjusted mortality rates per 100 000 people, due to HF‐related death among subjects with AF aged ≥15 years. To calculate nationwide annual trends, we assessed the average annual percent change (AAPC) and annual percent change with relative 95% CIs using joinpoint regression. Between 1999 and 2020, 916 685 HF‐related deaths (396 205 men and 520 480 women) occurred among US adults having a concomitant AF. The overall age‐adjusted mortality rates increased (AAPC: +4.1% [95% CI, 3.8–4.4]; P <0.001), especially after 2011 (annual percent change, +6.8% [95% CI, 6.2–7.4]; P <0.001) in men (AAPC, +4.8% [95% CI, 4.4–5.1]; P <0.001), in White subjects (AAPC: +4.2% [95% CI, 3.9 to 4.6]; P <0.001) and in subjects aged <65 years (AAPC: +7.5% [95% CI, 6.7–8.4]; P <0.001). The higher percentage of deaths were registered in the South (32.8%). During the first year of the COVID‐19 pandemic, a significant excess in HF‐related deaths among patients with AF aged >65 years was observed. Conclusions A worrying increase in the HF‐related mortality rate among patients with AF has been observed in the United States over the past 2 decades.

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Section: Discussioncontrasting

confidence: 52%

Heart Failure–Related Death in Subjects With Atrial Fibrillation in the United States, 1999 to 2020

Zuin,

Bertini,

Vitali

et al. 2024

JAHA

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“…Moreover, in the perspective of a comprehensive overview of the potential therapeutic effects of SGLT2 inhibitors on AF in HFpEF, it will be important to investigate the impact of these agents on progression of AF burden, and on related clinical events, also in terms of HF hospitalizations, stroke and death. This type of very accurate assessments can nowadays be performed through continuous rhythm monitoring by means of cardiac implantable electronic devices 14 …”

Section: Figurementioning

confidence: 99%

“…This type of very accurate assessments can nowadays be performed through continuous rhythm monitoring by means of cardiac implantable electronic devices. 14 Taking into account the convergence of AF and HFpEF, on the basis of common pathophysiological pathways involving inflammation, 2 there is a need to analyse and characterize the extent of atrial cardiomyopathy, whose evolution may modulate the clinical course of AF and HF, with important implications for patient outcomes. Indeed, there is growing interest in the role of atrial cardiomyopathy not only with regard to AF and HFpEF clinical convergence but also with regard to the risk of stroke and clinical outcome, independently of AF.…”

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confidence: 99%

Therapeutic effects of sodium–glucose cotransporter 2 inhibitors in patients with heart failure with preserved ejection fraction: From outcome improvement to potentially favourable influences on atrial fibrillation burden, atrial fibrillation progression and atrial cardiomyopathy

Boriani

Mei

Imberti

2023

European J of Heart Fail

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This article refers to 'Empagliflozin in heart failure with preserved ejection fraction with and without atrial fibrillation' by G. Filippatos et al., published in this issue on pages 970-977.Atrial fibrillation (AF) and heart failure (HF) frequently coexist, but the link is particularly tight in HF with preserved ejection fraction (HFpEF). Taking into account the whole spectrum of HF patients, the prevalence of AF appears to be higher when HF is diagnosed in association with higher values of left ventricular ejection fraction (EF). 1 Indeed, there is an important interdependence between HFpEF and AF, related to common pathophysiological pathways involving inflammation and fibrosis, leading to a frequent convergence of the two clinical manifestations. 2 Sodium-glucose cotransporter 2 (SGLT2) inhibitors are a cornerstone of pharmacological treatment of both diabetes and HF, 3,4 and in consideration of the mutual interrelationships 2,3 there is growing interest in evaluating the clinical effects on the risk of AF and AF-related outcomes.In this issue of the Journal, Filippatos et al. 5 present an interesting pre-defined secondary analysis of the EMPEROR-Preserved trial, comparing the effects of empagliflozin versus placebo on primary and secondary endpoints, as well as on safety outcomes, stratified

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“…However, amid these obstacles, a ray of light glows as disability ages descend in we-lloff nations. This hints at a useful tactic to tackle the broad impact of these conditions [5].…”

Section: Introductionmentioning

confidence: 99%

Unraveling the Complexity: From Molecular Subtypes to Therapeutic Strategies in Heart Failure with Preserved Ejection Fraction and Atrial Fibrillation

Fahimi,

Beikmohammadi,

Rostami

2024

Preprint

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fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF). Join us on a journey that unravels the mysteries of molecular intricacies, delves into advanced imaging techniques, and sheds light on therapeutic pathways. Unveiling the role of cardiac amyloidosis, particularly sub-clinical isolated cardiac amyloidosis (ICA), the narrative unfolds the heightened risk of AF in the elderly. State-of-the-art imaging techniques like cardiac magnetic resonance (CMR) and molecular imaging step into the spotlight, unraveling diagnostic and prognostic nuances of AF and HFpEF. Embarking on the molecular voyage, the article navigates through next-generation sequencing and comprehensive genomic profiling, shedding light on genetic alterations shaping the AF-HFpEF landscape. This molecular compass lays the groundwork for personalized medicine, illuminating pathways to identify therapeutic bullseyes and biomarkers. In the realm of medical strategies, the discussion homes in on the promising notes struck by SGLT2 inhibitors, particularly dapagliflozin, orchestrating a reduction in AF burden. Characters like spironolactone and dronedarone make appearances, each weaving a distinct tale, revealing their potential roles in steering the ship for AF- HFpEF patients. The subplot involving obesity in HFpEF unfolds, with the LEGACY study portraying the benefits of weight reduction. The pivotal intervention of catheter ablation emerges as the hero, boasting positive outcomes in reducing hospitalization rates and overall mortality for AF-HFpEF patients. However, cautionary tales echo about its impact on left atrial function, adding layers of complexity that beckon careful consideration and monitoring. Amidst the narrative, critical discussions unfold about the limitations of current research, echoing the need to define acute heart failure, refine imaging techniques, and tailor management strategies. The narrative passionately advocates for a personalized touch in addressing AF-HFpEF, recognizing the unique blend of clinical and molecular personas. In essence, this review paints a vivid mural of AF-HFpEF, skillfully bridging the realms of molecular intricacies and the artistry of clinical management.

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The burden of atrial fibrillation in patients with preserved or mildly reduced heart failure: a call to action for detecting atrial fibrillation and improving outcome

Abstract: This article refers to 'Intersection of atrial fibrillation and heart failure with mildly reduced and preserved ejection fraction in >400 000 participants in the Get With The Guidelines-Heart Failure Registry' by R.B. Patel et al., published in this issue on pages 63-73.

Cited by 6 publications

References 22 publications

Heart Failure–Related Death in Subjects With Atrial Fibrillation in the United States, 1999 to 2020

Heart Failure–Related Death in Subjects With Atrial Fibrillation in the United States, 1999 to 2020

Therapeutic effects of sodium–glucose cotransporter 2 inhibitors in patients with heart failure with preserved ejection fraction: From outcome improvement to potentially favourable influences on atrial fibrillation burden, atrial fibrillation progression and atrial cardiomyopathy

Unraveling the Complexity: From Molecular Subtypes to Therapeutic Strategies in Heart Failure with Preserved Ejection Fraction and Atrial Fibrillation

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