<i>European Journal of Heart Failure</i> Consensus Statement. Heart Failure Pharmacotherapy for Patients with Heart Failure with Reduced Ejection Fraction and Concomitant Atrial Fibrillation: Review of Evidence and Call to Action
Heart failure (HF) and atrial fibrillation (AF) are major global health challenges with rising prevalence and significant morbidity, mortality, and healthcare burden. Despite advances in HF management, AF remains a critical comorbidity that worsens outcomes and requires ad hoc treatment strategies, increasing the risk of non-adherence and side effects. While rhythm control strategies in AF have gained attention for their prognostic benefits in HF, the pharmacological treatment of HF in patients with AF, including the benefit of rhythm versus rate control, remains underexplored. The relationship between HF and AF lacks sufficient evidence and targeted research to assess the optimal treatment strategies. This narrative review critically examines current HF pharmacotherapy in the context of AF, focusing on the four cornerstone treatments and modifiers of prognosis for HF with reduced ejection fraction: beta-blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers/sacubitril-valsartan, aldosterone antagonists, and sodium-glucose co-transporter 2 inhibitors. Although these therapies are well-established in HF patients, their efficacy in patients with concomitant AF requires further prospective investigation. The unique challenges posed by AF, including arrhythmia-induced remodelling and cardiomyopathy, necessitate a more individually tailored treatment. We also highlight critical knowledge gaps and the need for dedicated clinical trials specifically assessing HF therapies in AF subgroups, such as paroxysmal, long-standing persistent and permanent AF, and the benefit of heart rate and rhythm control strategies. The future of precision medicine in HF-AF management lies in bridging these evidence gaps through targeted research and interdisciplinary collaboration.
Authors
- Juan Tamargo (ORCID: https://orcid.org/0000-0002-7979-7758)
- Christian Sohns (ORCID: https://orcid.org/0000-0003-0490-5862)
- Mark C. Petrie (ORCID: https://orcid.org/0000-0002-6333-9496)
- Erik Lerkevang Grove (ORCID: https://orcid.org/0000-0002-1466-0865)
- Antoni Bayés‐Genís (ORCID: https://orcid.org/0000-0002-3044-197X)
- Samuel Tobias Sossalla (ORCID: https://orcid.org/0000-0001-8034-2673)
- Dobromir Dobrev (ORCID: https://orcid.org/0000-0002-4612-117X)
- João Morais (ORCID: https://orcid.org/0000-0003-3406-2878)
- Giuseppe Ambrosio (ORCID: https://orcid.org/0000-0002-9677-980X)
- Claudio Borghi (ORCID: https://orcid.org/0000-0001-8039-8781)
- Patrick Sulzgruber (ORCID: https://orcid.org/0000-0001-5146-0099)
- Bianca Rocca (ORCID: https://orcid.org/0000-0001-8304-6423)
- Michele Senni (ORCID: https://orcid.org/0000-0001-5502-7882)
- Anne Grete Semb (ORCID: https://orcid.org/0000-0003-2730-2853)
- Heinz Drexel
- Elisabetta Cerbai (ORCID: https://orcid.org/0000-0001-7839-1361)
- Roland Klingenberg (ORCID: https://orcid.org/0000-0002-7726-4421)
- William A. Parker (ORCID: https://orcid.org/0000-0002-7822-8852)
- Mark Luedde (ORCID: https://orcid.org/0000-0002-3448-0351)
- Gheorghe Andrei Dan
- Stefan Agewall
- Péter Ferdinandy
- Juan Carlos Kaski
- Michael Böhm (ORCID: https://orcid.org/0000-0002-2976-2514)
- Marco Metra
Institutions
- Semmelweis University (HU)
- Libera Università Maria SS. Assunta (IT)
- Carol Davila University of Medicine and Pharmacy (RO)
- St George's, University of London (GB)
- Instituto Politécnico de Leiria (PT)
- Baylor College of Medicine (US)
- Justus-Liebig-Universität Gießen (DE)
- Aarhus University (DK)
- University of Perugia (IT)
- Montreal Heart Institute (CA)
- Heart and Diabetes Center North Rhine-Westphalia (DE)
- Aarhus University Hospital (DK)
- Karolinska Institutet (SE)
- Hospital General Universitario Gregorio Marañón (ES)
- Academia Oamenilor de Știință din România (RO)
- Hochschule Bremerhaven (DE)
- Universitätsklinikum des Saarlandes (DE)
- Centro de Investigación en Red en Enfermedades Cardiovasculares (ES)
- Glanrhyd Hospital (GB)
- Surgical Specialties (Canada) (CA)
- Ospedale Papa Giovanni XXIII (IT)
- Diakonhjemmet Hospital (NO)
- Vorarlberg Institute for Vascular Investigation and Treatment (AT)
- Kerckhoff Klinik (DE)
- Hospital zum Heiligen Geist (DE)
- LUM Jean Monnet University (IT)
- Klinikum Bremerhaven-Reinkenheide (DE)
- Hospital Universitari Germans Trias i Pujol (ES)
- Cardio-Pulmonary Institute (DE)
- Technology Transfer Center Bremerhaven (DE)
- West German Heart and Vascular Center Essen (DE)
- University of Florence (IT)
- University of Milano-Bicocca (IT)
- Medical University of Vienna (AT)
- University of Glasgow (GB)
- University of Brescia (IT)
- University of Sheffield (GB)
- University of Bologna (IT)
- University for Foreigners Perugia (IT)
Publication Details
- Journal
- European Journal of Heart Failure
- Published
- 2025-10-22
- DOI
- https://doi.org/10.1002/ejhf.70069
- Citations
- 1
- Primary Topic
- Atrial Fibrillation Management and Outcomes
- Type
- article
- Field-Weighted Citation Impact
- 1.39
Funders
- Amgen
- Bristol-Myers Squibb
- Eli Lilly and Company
- Pfizer
- AstraZeneca
- Sanofi
- Boston Scientific Corporation
- Regeneron Pharmaceuticals
- Amarin Corporation
- Cytokinetics
- Moderna
- Horizon Therapeutics
- European Commission
- Bayer HealthCare
- Deutsche Forschungsgemeinschaft
- Novo Nordisk
- Servier
- H. Lundbeck A/S
- Cardio-Pulmonary Institute
- National Institutes of Health
- Daiichi Sankyo Europe