This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Nieuwlaat, R. Articles by Crijns, H. J.G.M. Search for Related Content PubMed Articles by Nieuwlaat, R. Articles by Crijns, H. J.G.M. Related Collections Related Article

CLINICAL RESEARCH: ARRHYTHMIAS AND HEART FAILURE

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

Robby Nieuwlaat, PhD^_*,_*, Luc W. Eurlings, MD^_*, John G. Cleland, MD, PhD, Stuart M. Cobbe, MD, PhD, Panos E. Vardas, MD, PhD, Alessandro Capucci, MD, PhD^||, José L. López-Sendòn, MD, PhD^¶, Joan G. Meeder, MD, PhD^#, Yigal M. Pinto, MD, PhD^_** and Harry J.G.M. Crijns, MD, PhD^_*

^_* Department of Cardiology, University Hospital Maastricht, Maastricht, the Netherlands
Department of Cardiology, University of Hull, Castle Hill Hospital, Kingston upon Hull, United Kingdom
Section of Medical Cardiology and Exercise Medicine, Glasgow Royal Infirmary University NHS Trust, Glasgow, United Kingdom
Department of Cardiology, University Hospital of Heraklion, Crete, Greece
^|| Department of Cardiology, Guglielmo da Saliceto Hospital, Piacenza, Italy
^¶ Department of Cardiology, Hospital Universitario Gregorio Maranon, Madrid, Spain
^# Department of Cardiology, VieCuri Medical Center, Venlo, the Netherlands
^_** AMC, Heart Failure Research Centre, University of Amsterdam, Amsterdam, the Netherlands

Manuscript received March 31, 2008; revised manuscript received January 8, 2009, accepted January 12, 2009.

^_* Reprint requests and correspondence: Dr. Robby Nieuwlaat, Department of Cardiology, University Hospital Maastricht, P. Debyelaan 25, 6202AZ Maastricht, the Netherlands (Email: nieuwlaatrobby{at}live.com.au).

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 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.

Key Words: atrial fibrillation • heart failure • guidelines • management • prognosis

Abbreviations and Acronyms   ACEI = angiotensin-converting enzyme inhibitor   AF = atrial fibrillation   ARB = angiotensin II receptor blocker   CAD = coronary artery disease   CI = confidence interval   COPD = chronic obstructive pulmonary disease   HF = heart failure   LVSD = left ventricular systolic dysfunction   NYHA = New York Heart Association   OAC = oral anticoagulation   OR = odds ratio   PSF = preserved systolic function

Related Article

Inside This Issue
J. Am. Coll. Cardiol. 2009 53: A24. [Full Text] [PDF]

This article has been cited by other articles:

				H. J.G.M. Crijns Primary prevention of atrial fibrillation by statins: still unresolved? Eur. Heart J., October 1, 2009; 30(19): 2302 - 2303. [Full Text] [PDF]

				R. Pisters, C. B. de Vos, R. Dennert, and H. J. Crijns Undetected paroxysmal atrial fibrillation in chronic heart failure patients: is it clinically relevant to catch the atrial phantom? Europace, October 1, 2009; 11(10): 1257 - 1259. [Full Text] [PDF]