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Atrial fibrillation (AF) unabashedly retains the title of most commonly sustained cardiac arrhythmia worldwide.1 It is known as a major cause of stroke by increasing its risk fivefold. As a result of widespread clinical education and the advent of technologies which avail novel and safer anticoagulants, an increasing number of healthcare professionals and patients alike now have awareness of stroke prevention in AF. This is a huge success. However, as notably stated by Weber et al2 in this issue of Heart, heart failure events occur more frequently than strokes after a diagnosis of AF. Heart failure has proven difficult to treat in patients with AF, creating some degree of frustration facing the challenges. Likewise, preventable risk factors such as obesity and excessive drinking can be uncomfortable truths to confront patients with and tough to work on.
Weber et al2 introduced their study by presenting a convincing and often repeated ground truth: AF and heart failure commonly occur comorbidly with shared pathophysiology. Both primary and secondary causes of AF and heart failure lead to atrial cardiomyopathy. In patients who have been diagnosed with AF, heart failure hospitalisation is a common event, leading to excess risk of all-cause mortality, with varying rates depending on how long patients were followed up.
One of the more well-known observations came from the ORBIT-AF (Outcomes Registry for Better Informed Treatment of Atrial Fibrillation) registry, which followed 6545 patients with AF from 173 participating sites. Heart failure subsequently developed in 236 patients (3.6%) over 2 years. These patients are three times more likely to be …
Contributors WC drafted the editorial. LF reviewed the editorial.
Funding The authors acknowledge funding from MAESTRIA Grant agreement ID: 965286. In addition, the Institute of Cardiovascular Sciences, University of Birmingham, has received an Accelerator Award by the British Heart Foundation AA/18/2/34218.
Competing interests LF has received institutional research grants and non-financial support from European Union, British Heart Foundation, Medical Research Council (UK), several biomedical companies and DFG. LF is listed as inventor of two patents held by University of Birmingham (Atrial Fibrillation Therapy WO 2015140571, Markers for Atrial Fibrillation WO 2016012783).
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Commissioned; internally peer reviewed.
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