Registry-randomized study to reduce the risk of heart failure in patients with atrial fibrillation

The most common and a potentially fatal consequence of atrial fibrillation in the long-term is the development of heart failure.

The association between atrial fibrillation and f heart failure, is complex, with one condition promoting the other (10.1016/j.hlc.2017.05.117).Current guidelines focus on improving quality of life by rhythm/rate-control and on reducing the risk of ischemic stroke with anticoagulants (doi 10.1093/eurheartj/ehw210).

Yet, no therapy is recommended to reduce the risk of heart failure, despite almost half of all deaths being secondary to cardiac disease and heart failure (doi 10.1016/j.jacc.2016.09.944).

The diagnosis of atrial fibrillation could act as a trigger to initiate pharmacotherapy to reduce the risk of subsequent heart failure.

Our plan is to use the existing infra-structure of the Swedish atrial fibrillation registry (AURICULA) to create a randomization module to include eligible patients.

We propose to randomize patients to a sodium-glucose cotransporter-2 (SGLT2) inhibitor, a group of drugs that have been shown to prevent or reduce the risk of heart failure in both patients with and without diabetes, or to a control group (receiving placebo). As atrial fibrillation is common, potential results could be available within 4-years of first inclusion.

The results of this study have the potential to affect many; within 2-years of atrial fibrillation diagnoses every sixth patient will develop heart failure.