JACC: A-fib, heart failure guidelines not followed for most EU patients

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The prescription rate of guideline-recommended drug therapy for atrial fibrillation (AF) and left ventricular systolic dysfunction-heart failure (LVSD-HF) is low, according to an observation study in the May 5 issue of the Journal of the American College of Cardiology.

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. Robby Nieuwlaat, PhD, from the department of cardiology at the University Hospital Maastricht in Maastricht, the Netherlands, and colleagues performed a follow-up survey after one year.

At baseline, the researchers reported that 34 percent of the patients had HF. They found that the recommended therapy for HF patients 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 percent of HF patients, while 29 percent 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.

Nieuwlaat and colleagues noted that rate control was insufficient with 40 percent of all HF patients with permanent AF having a heart rate less than 80 beats per minute. In the total cohort, HF patients had a higher risk for mortality (9.5 vs. 3.3 percent, progression of HF (24.8 vs. 5 percent) and AF progression (35 vs. 19 percent) during one-year of follow up. Of all recommended drugs for AF and LVSD-HF, only ACEI prescription was associated with improved survival during one-year of follow up.

They researchers noted that it was "remarkable" though that they did not find a difference between LVSD-HF and PSF-HF [preserved left ventricular systolic function] for the application of recommended drugs for LVSD-HF. "This might indicate that left ventricular function does not play a major role in the decision to apply recommended therapy in patients with AF and HF."

The authors suggested that randomized controlled trials targeting this highly prevalent subgroup with AF and HF are warranted.