Heart failure the biggest problem with AF: Research

New research involving more than 3.5 million people has shown that heart failure, not stroke, is the most common complication of atrial fibrillation – challenging traditional risk perceptions associated with the condition.
 
The recent Danish Center for Health Services study is reportedly the first to examine the lifetime risk of complications following atrial fibrillation (AF), and suggests the probability of developing heart failure (42%) is almost double that of stroke (22%).
 
These findings contradict the commonly held view that stroke is the most prominent danger to patients with AF and could highlight the need for more heart failure prevention strategies alongside treatments to decrease stroke risk.
 
AF is the most common arrhythmia and a significant health problem in Australia, according to the Australian Institute of Health and Welfare. It leads to more than 200,000 hospitalisations per year and resulted in 16,000 fatalities in 2021, equating to almost 10% of all deaths that year.
 
Stroke is without doubt a key danger associated with AF. Patients with underlying AF face double the risk of death compared to strokes caused by other conditions.
 
However, the burden of heart failure cannot be ignored.
 
Thirty-thousand new cases of heart failure are diagnosed in Australia each year and the condition is recorded as the primary cause of death in 4700 cases, as well as an associated cause of death for 21,300 people annually.
 
By being the first to analyse the risks temporally over two decades (2000–22), the study’s authors are hoping to shift thinking about AF internationally and inform new health policy.
 
‘Although atrial fibrillation guidelines principally focus on stroke prevention, our findings indicate that heart failure was the major complication … with a lifetime risk of two in five patients with atrial fibrillation, twice greater than that of stroke,’ they reported.
 
‘Communication of lifetime risk estimates may motivate preventive strategies, such as beneficial changes in lifestyle … weight loss and risk factor modification and designing successful programs for cardiac rehabilitation.’
 
Victorian GP and University of Melbourne academic Associate Professor Ralph Audehm told newsGP that heart failure is an important and preventable complication of AF, and vice versa.
 
He believes GPs are in a ‘fantastic position’ to tackle the health problems of AF and heart failure and advocates for a collaborative approach between the patients, their GPs and cardiologists.
 
‘As a general rule now for my younger patients with atrial fibrillation, I do refer to a cardiologist for consideration of cardioversion to prevent complications,’ Associate Professor Audehm said.
 
‘However, it is important to remember that GPs play the long game. We are fortunate enough to be able to see our patients far more readily and more often than cardiologists.’
 
He also pointed to evidence showing that patients are more likely to survive heart problems with a shared care model.
 
‘After discharge from hospital for initial treatment of heart failure, we know that if their medications are commenced and optimised within the first two weeks, a patient is less likely to require more hospitalisations and less likely to die,’ Associate Professor Audehm said.
 
‘We also know that it is difficult for a patient to see a cardiologist in clinic within two weeks of being discharged.
 
‘So, without active input from a patient’s GP, we’ve missed a window of opportunity.’
 
However, he believes more needs to be done to support both the patients and the GPs in managing AF and heart failure.
 
‘Atrial fibrillation and heart failure are lifestyle diseases with many mutual risk factors such as being overweight, sedentary and having high blood pressure,’ he said.
 
‘It has been clinically proven that if you work with these patient to engage in an exercise program, resistance training and if they lose weight, their chance of survival dramatically improves.
 
‘It is therefore ludicrous that forming team care arrangements for chronic disease only provides the patient with up to five subsidised visits with allied health, such as an exercise physiologist, and not any more than that.
 
‘We should also be improving access to more group-based activities for patients with heart failure, much in the same way that we have developed subsided exercise programs for those with type 2 diabetes.
 
‘The peer-support element amongst the groups is crucial.’
 
Proper management of heart failure also comes with its unique complexities in rural Australia.
 
Distance to services, inadequate consultation time and low service availability are some of the barriers faced by those living in the country.
 
Associate Professor Audehm and his colleagues are currently investigating ways to improve access and patient care. Initiatives include telehealth services for GPs to immediately discuss plans with heart failure cardiologists and heart failure nurse practitioners who are able to visit and support GPs and patients in their regional locations.
 
‘If you give GPs the proper resources, they can really make a difference in heart conditions,’ he said.
 
‘GPs shouldn’t be afraid to tackle heart failure aggressively. At the end of the day, it means less hospital for the patient and less deaths.’
 
Log in below to join the conversation.

atrial fibrillation heart disease heart failure stroke