Zobdeh Amirreza, Hoyle Daniel J, Shastri Pankti, Bezabhe Woldesellassie M, Peterson Gregory M
School of Pharmacy and Pharmacology, University of Tasmania, Hobart, TAS, Australia.
Launceston Clinical School, Tasmanian School of Medicine, University of Tasmania, Launceston, TAS, Australia.
Am J Cardiovasc Drugs. 2025 Mar;25(2):147-155. doi: 10.1007/s40256-024-00703-y. Epub 2024 Nov 24.
Atrial fibrillation (AF) is the most common type of chronic arrythmia, with a lifetime prevalence of one in every three to five individuals above the age of 45 years. The higher heart rate, abnormal rhythm and inflammation caused by AF lead to changes in the function and structure of the heart. This, over time, can culminate in heart failure. In patients with AF, the lifetime prevalence of new-onset heart failure is twice that of stroke. The development of new-onset heart failure in AF is associated with high mortality. Despite the emphasis that AF guidelines put on preventing cardiovascular comorbidities, there is limited evidence regarding pharmacological therapies to prevent incident heart failure in individuals with AF. Specifically, the association between the use of rate control agents and incident heart failure in this population is unknown. Whilst rhythm control may reduce the risk of heart failure, the comparative effect of each pharmacological agent is not clear. In select subgroups of patients with AF, the choice of direct-acting oral anticoagulants and their optimal dosing has been attributed to a lower risk of new-onset heart failure. Future research is needed to identify an evidence-based approach to minimizing the development of heart failure in patients with AF.
心房颤动（AF）是最常见的慢性心律失常类型，45岁以上人群中每三到五人就有一人终生患病。房颤导致的心率加快、心律异常和炎症会引起心脏功能和结构的改变。随着时间的推移，这可能会导致心力衰竭。在房颤患者中，新发心力衰竭的终生患病率是中风的两倍。房颤患者新发心力衰竭与高死亡率相关。尽管房颤指南强调预防心血管合并症，但关于预防房颤患者发生心力衰竭的药物治疗的证据有限。具体而言，该人群中使用心率控制药物与发生心力衰竭之间的关联尚不清楚。虽然节律控制可能会降低心力衰竭的风险，但每种药物的相对效果尚不清楚。在特定的房颤患者亚组中，直接口服抗凝剂的选择及其最佳剂量已被认为可降低新发心力衰竭的风险。需要进一步的研究来确定一种基于证据的方法，以尽量减少房颤患者心力衰竭的发生。
