Integrated Care in Patients with Atrial Fibrillation and Optimal Medical Treatment for Heart Failure: Results from the Heart failuRe ObsErvational Study (HEROES).

Background: Heart failure (HF) and atrial fibrillation (AF) often coexist, and this has a major impact on prognosis. Only a limited amount of data is available on the effect of integrated strategies to improve prognosis in patients with HF and AF. We aimed to evaluate the association between HF subtype, HF optimal medical therapy (OMT), adherence to the Atrial Fibrillation Better Care (ABC) pathway, and all-cause death. Methods: Hospitalized patients and outpatients were enrolled in the Heart failuRe ObsErvational Study, which is a prospective, multicenter cohort study, between April 2022 and January 2024. Our analysis included patients with both HF and AF, who were divided into three groups: ABC + OMT, noABC + OMT, and noABC + noOMT. Results: A total of 627 patients, of whom 51.7% had HF with reduced ejection fraction, were included in this study. Direct oral anticoagulants were prescribed to 70.8% of patients, and 71.6% of these received the recommended doses. The patients were divided into the following groups: 49.8% were assigned to the ABC + OMT group, 25.2% to the noABC + OMT group, and 25% to the noABC + noOMT group. All-cause death occurred in 19.5% of patients. OMT compliance was associated with lower risk of all-cause death (HR0.61, 95% CI 0.42-0.9, p = 0.01), whereas management compliant with the ABC pathway was not (HR0.74, 95% CI 0.51-1.09, p = 0.12). In the ABC + OMT group, the risk of all-cause death was lower than in the noABC + noOMT group (HR0.60, 95% CI 0.39-0.92, p = 0.02). Conclusions: Integrated treatment strategies were implemented in half of the population with HF and AF, and this was associated with better long-term prognosis compared with patients who did not receive a complex treatment strategy.