Heart failure greater risk than stroke in AF patients

What should clinicians be focusing on?

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Heart failure rates in people with atrial fibrillation are double those of stroke, with two in every five AF patients experiencing heart failure, research shows.

Analysis of over 20 years of Danish data, including 360,000 people with AF showed that, over the duration of the study 42% of the cohort developed heart failure, while only 21% experienced stroke.

The study also looked at the trends in cardiovascular complication over time after atrial fibrillation. There was a minor decrease in lifetime risk of heart failure, moving from 42.9% in 2000-10 to 42.1% in 2011-22. The lifetime risks of stroke and myocardial infarction also decreased slightly between the two periods, from 22.4% to 19.9% for stroke, and 13.7% to 9.8% for myocardial infarction.

The findings suggest that while most research and guidelines around atrial fibrillation focus on preventing stroke, there needs to be greater attention given to heart failure prevention, the study authors said.

Cardiologist David Colquhoun, associate professor of medicine at the University of Queensland, suggests a proactive approach and adherence to treatment guidelines.

“We need to be screening for and treating comorbidities in AF patients. Atrial fibrillation is not a cause of heart failure, it’s a comorbidity in this age group,” he told The Medical Republic.

When a patient presents with atrial fibrillation, Professor Colquhoun said, it’s an opportunity to screen for impaired left ventricular function and depression, which are major predictors for further cardiovascular events, as well as check patient lipids and assess how their blood pressure and diabetes are managed.

“If you’ve got hypertension, then you have at least double the risk of another patient with atrial fibrillation,” he says.

“Clinicians then need to treat appropriately. [Diagnosis is] an ideal opportunity for risk prevention – we have treatments for depression, hypertension and diabetes which are proven to improve survival. [The study] is likely of patients who are not being treated appropriately for their risk factors.”

According to the Danish researchers, more than 85% of patients with atrial fibrillation are prescribed oral anticoagulation therapy, and more than 85% are still taking the treatment after two years.

Treating risk factors and pushing adherence to treatment should be the focus, he says.

The BMJ 2024, online 17 April