For patients with atrial fibrillation (AF), the main goals of therapy are control of symptoms and prevention of arterial thromboembolism, particularly stroke. These goals are also appropriate for the relatively large subset of AF patients with heart failure (HF). In these individuals, symptoms are frequent and potentially disabling due to the interaction between the two processes.
This topic will focus on the management of AF in patients with HF. There are few differences in management between those with systolic or diastolic HF. (See "Overview of the therapy of heart failure due to systolic dysfunction" and "Use of beta blockers in heart failure due to systolic dysfunction" and "Treatment and prognosis of diastolic heart failure" and "Pathophysiology of diastolic heart failure" and "Clinical manifestations and diagnosis of diastolic heart failure".)
The reader will be referred to other AF topics for which care is relatively similar irrespective of the presence of HF. (See "Atrial fibrillation: Anticoagulant therapy to prevent embolization", section on 'Summary and recommendations' and "Catheter ablation to prevent recurrent atrial fibrillation", section on 'Heart failure' and "Control of ventricular rate in atrial fibrillation: Pharmacologic therapy".)
INCIDENCE AND PREVALENCE
Atrial fibrillation (AF) and heart failure (HF) are two cardiac diseases that may co-exist. The presence of one increases the likelihood of the development of the other .
The incidence of AF in patients HF was examined in an analysis from the Framingham Heart Study in which 1470 participants developed AF, HF, or both over a 47-year interval . Among the 708 who developed HF (the study does not state what percent of patients had systolic or diastolic HF) without prior AF, 159 (22 percent) subsequently developed AF over a mean follow-up of 4.2 years (incidence rate 5.4 percent per year) (figure 1). Somewhat similar findings were noted for patients who developed AF first; the subsequent incidence of HF was 3.3 percent per year. An association between left ventricular diastolic dysfunction and AF was established in a study of 840 patients ≥65 years of age, 80 of whom developed AF over a mean follow-up of four years . Patients with abnormal diastolic function had an increased risk of AF compared to those with normal diastolic function. (See "Pathophysiology of diastolic heart failure" and "Clinical manifestations and diagnosis of diastolic heart failure" and "Treatment and prognosis of diastolic heart failure".)