Bonini Niccolò, Proietti Marco, Romiti Giulio Francesco, Vitolo Marco, Fawzy Ameenathul Mazaya, Ding Wern Yew, Imberti Jacopo Francesco, Fauchier Laurent, Marin Francisco, Nabauer Michael, Dan Gheorghe Andrei, Potpara Tatjana S, Boriani Giuseppe, Lip Gregory Y H
Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital Liverpool United Kingdom.
Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences University of Modena and Reggio Emilia, Policlinico di Modena Modena Italy.
J Am Heart Assoc. 2025 Jan 7;14(1):e030499. doi: 10.1161/JAHA.123.030499. Epub 2024 Dec 20.
Heart failure (HF) often occurs in patients with atrial fibrillation (AF), with a major impact on prognosis. Few data are available on the effect of integrated treatment strategies to improve prognosis in patients with AF. We aimed to evaluate the association between HF (according to left ventricular ejection fraction [LVEF]), HF optimal medical therapy and adherence to the Atrial Fibrillation Better Care pathway, and major outcomes in patients with AF.
From the ESC-EHRA EORP-AF (European Society of Cardiology-European Heart Rhythm Association EURObservational Research Programme in Atrial Fibrillation) General Long-Term Registry, we evaluated patients with HF, categorized according to LVEF (HF with reduced ejection fraction, HF with mildly reduced ejection fraction, HF with preserved ejection fraction). Optimal medical therapy for HF was guidelines-defined. The primary end point was the composite of all-cause death and major adverse cardiovascular events. From the original cohort, 9373 (84.5%) patients were included in this analysis (median age, 71 [interquartile range, 62-77] years; 39.9% women). Compared with no HF, all HF categories were associated with an increased risk of the primary composite outcome, with highest figures observed for HF with reduced ejection fraction (hazard ratio [HR], 2.36 [95% CI, 2.00-2.78]). The risk was reduced in patients with AF and HF adherent to optimal medical therapy (HR, 0.83 [95% CI, 0.70-0.98]), as well as in those adherents to the Atrial Fibrillation Better Care pathway (HR, 0.65 [95% CI, 0.48-0.88]). The effect of Atrial Fibrillation Better Care pathway was consistent across the spectrum of LVEF.
Patients with AF and HF have a high risk of major adverse events, and this risk is inversely associated with LVEF. Atrial Fibrillation Better Care pathway adherent management is associated with improved clinical outcomes in patients with HF, across the spectrum of LVEF.
心力衰竭（HF）常发生于心房颤动（AF）患者中，对预后有重大影响。关于综合治疗策略对改善AF患者预后的效果，目前可用数据较少。我们旨在评估HF（根据左心室射血分数[LVEF]）、HF最佳药物治疗以及对心房颤动更佳治疗路径的依从性与AF患者主要结局之间的关联。
从ESC-EHRA EORP-AF（欧洲心脏病学会-欧洲心律协会心房颤动欧洲观察性研究项目）总体长期注册研究中，我们评估了HF患者，根据LVEF进行分类（射血分数降低的HF、射血分数轻度降低的HF、射血分数保留的HF）。HF的最佳药物治疗由指南定义。主要终点是全因死亡和主要不良心血管事件的复合终点。在原始队列中，9373例（84.5%）患者纳入本分析（中位年龄71岁[四分位间距62 - 77岁]；39.9%为女性）。与无HF相比，所有HF类别均与主要复合结局风险增加相关，射血分数降低的HF风险最高（风险比[HR]，2.36[95%CI，2.00 - 2.78]）。AF合并HF且坚持最佳药物治疗的患者风险降低（HR，0.83[95%CI，0.70 - 0.98]），坚持心房颤动更佳治疗路径的患者也是如此（HR，0.65[95%CI，0.48 - 0.88]）。心房颤动更佳治疗路径的效果在LVEF范围内是一致的。
AF合并HF患者发生主要不良事件的风险较高，且该风险与LVEF呈负相关。在LVEF范围内，坚持心房颤动更佳治疗路径管理与HF患者临床结局改善相关。
