European Journal of Heart Failure 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

Sep 29, 2026

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European Journal of Heart Failure consensus statement presents a narrative review of current pharmacotherapy for patients with heart failure with reduced ejection fraction (HFrEF) complicated by atrial fibrillation (AF). It addresses how AF aggravates outcomes and why tailored treatment strategies are needed, noting limited evidence on optimal drug choices and the relative role of rhythm versus rate control. The review focuses on four cornerstone HF therapies and prognosis modifiers: beta-blockers, ACEi/ARB/sacubitril-valsartan, aldosterone antagonists, and SGLT2 inhibitors.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages13

Reading Time33 min

AccessFree to download

Review of evidence and call to action

Heart failure and atrial fibrillation: clinical context

Cornerstone pharmacotherapy for HFrEF with AF

Prognosis modifiers and treatment implications

European Journal of Heart Failure (2025) 27, 2198–2210 REVIEW ARTICLE doi:10.1002/ejhf.70069 European Journal of Heart Failure 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 Mark Luedde 1,2, Stefan Agewall3, Giuseppe Ambrosio4,5, Antoni Bayes-Genis6, Claudio Borghi7, Elisabetta Cerbai8, Gheorghe A. Dan9, Heinz Drexel 10, Péter Ferdinandy 11, 12,13, Erik Lerkevang Grove 14,15, Juan Carlos Kaski 16, Roland Klingenberg 17,18, Joao Morais 19, William Parker20, Mark C . Petrie21, Bianca Rocca22, Anne Grete Semb23, Michele Senni24, Christian Sohns25, Patrick Sulzgruber26, Juan Tamargo27, Marco Metra28, Michael Böhm29, Dobromir Dobrev30,31,32, and Samuel Sossalla 1, 17,33 * 1 Medical Clinic I, Cardiology and Angiology, Justus-Liebig-University, Giessen, Germany; 2 Cardiologicum Bremerhaven, Sanecum Group, Bremerhaven, Germany; 3 Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden; 4 Department of Medicine and CERICLET, University of Perugia School of Medicine, Perugia, Italy; 5 Institute for Cardiovascular Research-INRC, Perugia, Italy; 6 Heart Institute, Hospital Universitari Germans Trias I Pujol, CIBERCV, Badalona, Spain; 7 Department of Cardiovascular Medicine, University of Bologna-IRCCS AOU S. Orsola, Bologna, Italy; 8 Department Neuroscience, Section of Pharmacology and Toxicology, University of Florence, Florence, Italy; 9 Carol Davila University of Medicine and Pharmacy, Academy of Romanian Scientists, Bucharest, Romania; 10Vorarlberg Institute for Vascular Investigation & Treatment (VIVIT), Feldkirch, Austria; 11 Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary; 12Pharmahungary Group, Szeged, Hungary; 13Center for Pharmacology and Drug Research & Development, Semmelweis University, Budapest, Hungary; 14Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; 15Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark; 16Cardiovascular and Cell Sciences Research Institute at St George’s, University of London, London, UK; 17Medical Clinic I, Cardiology and Angiology, Justus-Liebig-University, Giessen and Department of Cardiology, Kerckhoff-Clinic/DZHK, Bad Nauheim, Germany; 18Krankenhaus Nordwest, Stiftung Hospital zum Heiligen Geist, Frankfurt, Germany; 19ciTechCare-Center for Innovative Care and Health Technology. Polytechnic University of Leiria, Leiria, Portugal; 20 Cardiovascular Research Unit, University of Sheffield, Sheffield, UK; 21School of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK; 22 Department of Medicine and Surgery, LUM University, Casamassima, Italy; 23 Preventive Cardio-Rheuma clinic, Division of Research and Innovation, REMEDY Centre, Diakonhjemmet Hospital, Oslo, Norway; 24 University of Milano-Bicocca, Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy; 25 Department of Electrophysiology, Herz-und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany; 26 Department of Medicine, Division of Cardiology, Medical University of Vienna, Vienna, Austria; 27 Department of Pharmacology and Toxicology, School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; 28 Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy; 29 Klinik für Innere Medizin III, HOMICAREM (HOMburg Institute for CArdioREnalMetabolic Medicine), Universitätsklinikum des Saarlandes, Saarland University, Homburg/Saar, Germany; 30 Institute of Pharmacology, West-German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany; 31Department of Medicine, Montreal Heart Institute and Université de Montréal, Montréal, QC, Canada; 32 Department of

FAQs

Why is atrial fibrillation considered a critical comorbidity in heart failure patients?

Atrial fibrillation worsens outcomes in heart failure and increases overall morbidity, mortality, and healthcare burden. It also requires ad hoc treatment strategies and may contribute to non-adherence and side effects.

What key pharmacotherapy classes are discussed as cornerstone treatments for HFrEF with AF?

The document highlights beta-blockers, ACE inhibitors/ARB/sacubitril-valsartan, aldosterone antagonists, and sodium–glucose co-transporter 2 inhibitors as core therapies and prognosis modifiers.

What evidence gap does the review aim to address regarding AF treatment in heart failure?

It notes that the relationship between heart failure and atrial fibrillation lacks sufficient evidence, and that targeted research is needed to assess optimal treatment strategies, including pharmacologic considerations relevant to rhythm versus rate control.

Sep 29, 2026

Uploaded by kopisore