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Atrial Fibrillation and Heart Failure: Diagnosis, Risk Stratification, and Clinical Management

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: 20 December 2026 | Viewed by 1424

Editor

Dr. Christian Grebmer

E-Mail Website
Guest Editor
Department of Cardiology, Kantonsspital Lucerne, Heart Center Lucerne, Spitalstrasse 16, 6002 Lucerne, Switzerland
Interests: cardiac electrophysiology; cardiac resynchronisation therapy; left bundle area pacing; conduction system pacing; sudden cardiac death; lead extractions

Special Issue Information

Dear Colleagues,

Atrial fibrillation (AF) and heart failure (HF) frequently coexist and are associated with increased risks of hospitalization, stroke, and mortality. Their coexistence complicates clinical management, particularly in relation to rhythm versus rate control, anticoagulation, and the optimization of heart failure therapy.

This Special Issue focuses on clinically relevant aspects of AF and HF, including diagnosis and phenotyping, risk stratification, and evidence-based management strategies. Topics of interest include anticoagulation in complex patients, integration of guideline-directed medical therapy, patient selection for catheter ablation, and management of acute and chronic HF in the presence of AF.

We welcome original clinical studies, real-world data analyses, and systematic reviews that provide actionable insights into patient management and clinical outcomes. Submissions addressing risk prediction, imaging, and biomarkers with direct clinical applicability are also encouraged.

Dr. Christian Grebmer
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-anonymized peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • atrial fibrillation
  • heart failure
  • clinical management
  • risk stratification
  • anticoagulation
  • catheter ablation
  • guide-line-directed therapy
  • clinical outcomes

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Published Papers (2 papers)

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Research

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16 pages, 1026 KB  
Article
GLP-1 Receptor Agonists or Dual GLP-1/GIP Receptor Agonists vs. SGLT2 Inhibitors in Patients with Atrial Fibrillation and HFpEF: A Propensity-Matched Real-World Analysis
by Faizan Ahmed, Najam Gohar, Madeeha Shafqat, Daniel Aziz, Mohammad Omar Butt, Hassaan Abid, Haziq Ahmad, Mohammad Saad Saeeduddin, Ch M Umer Zaman, Haris Bin Tahir, Muhammad Hassan, Qaiser Shahzad, Ayesha Zulfiqar, Amro Taha, Swapnil Patel and Eran S. Zacks
J. Clin. Med. 2026, 15(13), 4992; https://doi.org/10.3390/jcm15134992 - 26 Jun 2026
Viewed by 528
Abstract
Background: Atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF) usually coexist and are related to increased morbidity and mortality. Cardiovascular benefits have been demonstrated by drugs such as sodium-glucose cotransporter-2 inhibitors (SGLT2i) and GLP-1 receptor agonists including the dual [...] Read more.
Background: Atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF) usually coexist and are related to increased morbidity and mortality. Cardiovascular benefits have been demonstrated by drugs such as sodium-glucose cotransporter-2 inhibitors (SGLT2i) and GLP-1 receptor agonists including the dual GIP/GLP-1 receptor agonist tirzepatide (collectively, incretin-based therapies); however, their relative effectiveness in patients with concomitant AF and HFpEF remains undefined. Methods: We conducted a retrospective, propensity score-matched cohort study utilizing the TriNetX Global Collaborative Network. Adults with AF or atrial flutter with a diagnosis of HFpEF who initiated incretin-based therapies (GLP-1 receptor agonists or dual GLP-1/GIP receptor agonists) or SGLT2i were included; index medication was required to be initiated within 30 days of a qualifying AF/HFpEF diagnosis. 1:1 matching was performed based on baseline medications, demographics, and comorbidities. Co-primary outcomes were all-cause mortality, inpatient visits, and emergency department (ED) visits at 1 year. Secondary outcomes included myocardial infarction, ischemic stroke, acute kidney injury, transient ischemic attack, major adverse cardiovascular events (MACE; all-cause mortality/MI/stroke composite), and AF-related procedures. Agent-specific subgroup analyses were performed for semaglutide and tirzepatide separately. Sensitivity analyses were conducted at 6 months and 2 years. Results: 7624 patients were included in each cohort after matching (mean age: 70.8 years; 52% women). At 1 year, incretin-based therapy was associated with lower all-cause mortality (5.3% vs. 7.3%, HR 0.721, 95% CI 0.634–0.820; p < 0.001), fewer inpatient visits (30.0% vs. 37.4%, HR 0.743, 95% CI 0.702–0.787; p < 0.001), and no statistically significant difference in ED visits (27.0% vs. 28.0%; HR 0.946, 95% CI 0.888–1.007; p = 0.081) compared with SGLT2i. Incretin-based therapy was also associated with lower risk of MACE (HR 0.709), acute kidney injury (HR 0.751), myocardial infarction (HR 0.583), catheter ablation (HR 0.685), and electrical cardioversion (HR 0.472). No significant differences were observed in ischemic stroke or transient ischemic attack. These findings were broadly consistent at 6-month and 2-year follow-up, and directionally consistent in agent-specific subgroup analyses of semaglutide and tirzepatide. Conclusions: In this large propensity-matched cohort of patients with AF and HFpEF, initiation of incretin-based therapy (GLP-1 receptor agonists or dual GLP-1/GIP receptor agonists) was associated with lower all-cause mortality, fewer inpatient visits, and reduced cardiovascular events compared with SGLT2i. These findings, while subject to observational limitations, suggest potential benefits of incretin-based therapy in this high-risk population and support the need for prospective comparative trials. Full article
(This article belongs to the Special Issue Atrial Fibrillation and Heart Failure: Diagnosis, Risk Stratification, and Clinical Management)
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Review

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26 pages, 4016 KB  
Review
Atrial Fibrillation Risk Management and Emerging Therapies
by Megan Vaughan, Banveet Kaur and Nishaki K. Mehta
J. Clin. Med. 2026, 15(12), 4612; https://doi.org/10.3390/jcm15124612 - 14 Jun 2026
Viewed by 631
Abstract
Atrial fibrillation (AF) is the most common tachyarrhythmia worldwide. Accompanying the increasing age of the general population, as well as an increase in underlying cardiovascular disease in the United States, is an explosive rise in the incidence and prevalence of this condition. We [...] Read more.
Atrial fibrillation (AF) is the most common tachyarrhythmia worldwide. Accompanying the increasing age of the general population, as well as an increase in underlying cardiovascular disease in the United States, is an explosive rise in the incidence and prevalence of this condition. We reviewed observational cohort studies, systematic reviews, meta-analyses, and randomized controlled trials (RCTs) to determine both underlying risk factors and treatment of AF, with particular focus on comorbid conditions influencing treatment success. Numerous studies have demonstrated a reciprocal relationship between maladaptive cardiac remodeling and AF, with the suggestion that aggressive management of both AF itself and resultant cardiovascular disease can lead to reversal of both conditions. Ultimately, many modifiable risk factors for AF exist, with treatment delays associated with a shift towards these conditions becoming unmodifiable. While a large area of focus for AF research has been on determining the optimal pharmacological strategy (i.e., rate versus rhythm control), results have been mixed, with emerging guidelines now pointing towards a flexible treatment strategy that allows for consideration of patient comorbid conditions, medication ease and affordability, and patient preference. Treatment of AF also includes prevention of thromboembolic events. In recent years, novel strategies for surgical or physical occlusion of the left atrial appendage (LAA) with devices such as the Watchman have arisen. Multiple large RCTs have demonstrated the safety and efficacy of these devices, but consideration must be given towards the patient’s bleeding risk, as short-term courses of blood thinners are still considered the standard of care. Finally, emerging therapies for AF include novel drug combinations, neuromodulation devices, and potentially glucagon-like peptide receptor-1 (GLP-1) agonist medications for reduction in overall metabolic disease. Full article
(This article belongs to the Special Issue Atrial Fibrillation and Heart Failure: Diagnosis, Risk Stratification, and Clinical Management)
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