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The management of atrial fibrillation in heart failure: an expert panel consensus

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Abstract

Heart failure (HF) and atrial fibrillation (AF) often coexist, being closely interrelated as the one increases the prevalence and incidence and worsens the prognosis of the other. Their frequent coexistence raises several challenges, including under-diagnosis of HF with preserved ejection fraction in AF and of AF in HF, characterization and diagnosis of atrial cardiomyopathy, target and impact of rate control therapy on outcomes, optimal rhythm control strategy in the era of catheter ablation, HF-related thromboembolic risk and management of anticoagulation in patients with comorbidities, such as chronic kidney disease or transient renal function worsening, coronary artery disease or acute coronary syndromes, valvular or structural heart disease interventions and cancer. In the present document, derived by an expert panel meeting, we sought to focus on the above challenging issues, outlining the existing evidence and identifying gaps in knowledge that need to be addressed.

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Authors and Affiliations

  1. Shakolas Educational Center for Clinical Medicine, University of Cyprus Medical School, Palaios dromos Lefkosias Lemesou No.215/6, Aglantzia, 2029, Nicosia, Cyprus

    Dimitrios Farmakis

  2. Heart Failure Unit, Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece

    Dimitrios Farmakis & John Parissis

  3. First Department of Cardiology, Hippokratio Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece

    Christina Chrysohoou

  4. Department of Cardiology, University of Thessaly, Larissa, Greece

    Gregory Giamouzis

  5. First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece

    George Giannakoulas

  6. Department of Cardiology, University Hospital of Heraklion, Heraklion, Greece

    Michalis Hamilos

  7. Second Department of Cardiology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece

    Katerina Naka

  8. Department of Cardiology, Mitera General Hospital, Athens, Greece

    Stylianos Tzeis

  9. Department of Cardiology, Evangelismos Hospital, Athens, Greece

    Sotirios Xydonas

  10. Department of Cardiology, “G. Gennimatas” General Hospital, Athens, Greece

    Apostolos Karavidas

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Correspondence to Dimitrios Farmakis.

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DF: lecture honoraria and advisory board fees from Abbott Laboratories, Bayer, Boehringer Ingelheim, Menarini, Novartis, Orion Pharma and Roche Diagnostics; CC: honoraria from Boehringer Ingelheim and Novartis; G. Giamouzis: honoraria from Bayer, Boehringer Ingelheim and Pfizer; G. Giannakoulas: lecture honoraria and/or advisory boards from AstraZeneca, Bayer, Boehringer Ingelheim, ELPEN Pharmaceuticals, Genesis Pharma, Novartis, Pfizer, Roche and Servier; MH: honoraria from Astra Zeneca, Boehringer Ingelheim, Pfizer and Sanofi; KN: honoraria for participation in a clinical trial and contribution to advisory boards (all minor) from Boehringer Ingelheim; ST: lecture honoraria from Bayer, Boehringer Ingelheim and Pfizer; SX: lecture honoraria from Bayer, Boehringer Ingelheim, Merck, Novartis, Pfizer and Servier and advisory board fees from Boehringer Ingelheim, Novartis and Servier; AK: lectures honoraria and advisory board fees from Boehringer Ingelheim, Elpen, Genesis Pharma, Menarini, Novartis, Pfizer, Sanofi and Servier; JP: honoraria from Boehringer Ingelheim, Novartis, Pfizer, Roche Diagnostics and Servier.

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Farmakis, D., Chrysohoou, C., Giamouzis, G. et al. The management of atrial fibrillation in heart failure: an expert panel consensus. Heart Fail Rev 26, 1345–1358 (2021). https://doi.org/10.1007/s10741-020-09978-0

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