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Atrial fibrillation and heart failure in cardiology practice: reciprocal impact and combined management from the perspective of atrial fibrillation: results of the Euro Heart Survey on atrial fibrillation.
J Am Coll Cardiol. 2009 May 05; 53(18):1690-8.JACC

Abstract

OBJECTIVES

Our aim was to identify shortcomings in the management of patients with both atrial fibrillation (AF) and heart failure (HF).

BACKGROUND

AF and HF often coincide in cardiology practice, and they are known to worsen each other's prognosis, but little is known about the quality of care of this combination.

METHODS

In the observational Euro Heart Survey on AF, 5,333 AF patients were enrolled in 182 centers across 35 European Society of Cardiology member countries in 2003 and 2004. A follow-up survey was performed after 1 year.

RESULTS

At baseline, 1,816 patients (34%) had HF. Recommended therapy for HF with left ventricular systolic dysfunction (LVSD) with a beta-blocker and either an angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker was prescribed in 40% of HF patients, while 29% received the recommended drug therapy for both LVSD-HF and AF, consisting of the combination of a beta-blocker, either ACEI or angiotensin II receptor blocker, and oral anticoagulation. Rate control was insufficient with 40% of all HF patients with permanent AF having a heart rate < or =80 beats/min. In the total cohort, HF patients had a higher risk for mortality (9.5% vs. 3.3%; p < 0.001), (progression of) HF (24.8% vs. 5.0%; p < 0.001), and AF progression (35% vs. 19%; p < 0.001) during 1-year follow-up. Of all recommended drugs for AF and LVSD-HF, only ACEI prescription was associated with improved survival during 1-year follow-up (odds ratio: 0.51 [95% confidence interval: 0.31 to 0.85]; p = 0.011).

CONCLUSIONS

The prescription rate of guideline-recommended drug therapy for AF and LVSD-HF is low. Randomized controlled trials targeting this highly prevalent subgroup with AF and HF are warranted.

Authors+Show Affiliations

Department of Cardiology, University Hospital Maastricht, Maastricht, The Netherlands. nieuwlaatrobby@live.com.auNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19406345

Citation

Nieuwlaat, Robby, et al. "Atrial Fibrillation and Heart Failure in Cardiology Practice: Reciprocal Impact and Combined Management From the Perspective of Atrial Fibrillation: Results of the Euro Heart Survey On Atrial Fibrillation." Journal of the American College of Cardiology, vol. 53, no. 18, 2009, pp. 1690-8.
Nieuwlaat R, Eurlings LW, Cleland JG, et al. Atrial fibrillation and heart failure in cardiology practice: reciprocal impact and combined management from the perspective of atrial fibrillation: results of the Euro Heart Survey on atrial fibrillation. J Am Coll Cardiol. 2009;53(18):1690-8.
Nieuwlaat, R., Eurlings, L. W., Cleland, J. G., Cobbe, S. M., Vardas, P. E., Capucci, A., López-Sendòn, J. L., Meeder, J. G., Pinto, Y. M., & Crijns, H. J. (2009). Atrial fibrillation and heart failure in cardiology practice: reciprocal impact and combined management from the perspective of atrial fibrillation: results of the Euro Heart Survey on atrial fibrillation. Journal of the American College of Cardiology, 53(18), 1690-8. https://doi.org/10.1016/j.jacc.2009.01.055
Nieuwlaat R, et al. Atrial Fibrillation and Heart Failure in Cardiology Practice: Reciprocal Impact and Combined Management From the Perspective of Atrial Fibrillation: Results of the Euro Heart Survey On Atrial Fibrillation. J Am Coll Cardiol. 2009 May 5;53(18):1690-8. PubMed PMID: 19406345.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Atrial fibrillation and heart failure in cardiology practice: reciprocal impact and combined management from the perspective of atrial fibrillation: results of the Euro Heart Survey on atrial fibrillation. AU - Nieuwlaat,Robby, AU - Eurlings,Luc W, AU - Cleland,John G, AU - Cobbe,Stuart M, AU - Vardas,Panos E, AU - Capucci,Alessandro, AU - López-Sendòn,José L, AU - Meeder,Joan G, AU - Pinto,Yigal M, AU - Crijns,Harry J G M, PY - 2008/03/31/received PY - 2009/01/08/revised PY - 2009/01/12/accepted PY - 2009/5/2/entrez PY - 2009/5/2/pubmed PY - 2009/6/10/medline SP - 1690 EP - 8 JF - Journal of the American College of Cardiology JO - J Am Coll Cardiol VL - 53 IS - 18 N2 - OBJECTIVES: Our aim was to identify shortcomings in the management of patients with both atrial fibrillation (AF) and heart failure (HF). BACKGROUND: AF and HF often coincide in cardiology practice, and they are known to worsen each other's prognosis, but little is known about the quality of care of this combination. METHODS: In the observational Euro Heart Survey on AF, 5,333 AF patients were enrolled in 182 centers across 35 European Society of Cardiology member countries in 2003 and 2004. A follow-up survey was performed after 1 year. RESULTS: At baseline, 1,816 patients (34%) had HF. Recommended therapy for HF with left ventricular systolic dysfunction (LVSD) with a beta-blocker and either an angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker was prescribed in 40% of HF patients, while 29% received the recommended drug therapy for both LVSD-HF and AF, consisting of the combination of a beta-blocker, either ACEI or angiotensin II receptor blocker, and oral anticoagulation. Rate control was insufficient with 40% of all HF patients with permanent AF having a heart rate < or =80 beats/min. In the total cohort, HF patients had a higher risk for mortality (9.5% vs. 3.3%; p < 0.001), (progression of) HF (24.8% vs. 5.0%; p < 0.001), and AF progression (35% vs. 19%; p < 0.001) during 1-year follow-up. Of all recommended drugs for AF and LVSD-HF, only ACEI prescription was associated with improved survival during 1-year follow-up (odds ratio: 0.51 [95% confidence interval: 0.31 to 0.85]; p = 0.011). CONCLUSIONS: The prescription rate of guideline-recommended drug therapy for AF and LVSD-HF is low. Randomized controlled trials targeting this highly prevalent subgroup with AF and HF are warranted. SN - 1558-3597 UR - https://www.unboundmedicine.com/medline/citation/19406345/Atrial_fibrillation_and_heart_failure_in_cardiology_practice:_reciprocal_impact_and_combined_management_from_the_perspective_of_atrial_fibrillation:_results_of_the_Euro_Heart_Survey_on_atrial_fibrillation_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-1097(09)00545-2 DB - PRIME DP - Unbound Medicine ER -