Author + information
- Gerald Fletcher, MD∗ ()
- Cardio Vascular Department, College of Medicine, Mayo Clinic Florida, Jacksonville, Florida; and the Cardio Vascular Department, Mayo Clinic Florida, University of North Florida, Jacksonville, Florida
- ↵∗Address for correspondence:
Dr. Gerald Fletcher, Cardio Vascular Department, Mayo Clinic Florida, 4500 San Pablo Road, Davis Building, Jacksonville, Florida 32224.
Heart failure and atrial fibrillation (AF) are increasingly common, particularly in elderly patients. Increasingly, “eldercare” requires careful dosing of medications, proper timing of administration, assurance that all therapy is taken as prescribed, and that the elderly understand the importance of therapy for both their heart failure and AF (1). In this issue of the Journal, Luo et al. (2) provide valuable information on patients with heart failure who also have AF. The authors analyzed data from the HF-ACTION (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training) trial to determine the relationship between baseline AF status and outcomes with exercise training, and to determine future AF events.
A total of 1,984 patients who were included in the analysis underwent supervised exercise training, followed by a transition to home exercise program with an ultimate goal of 120 min of exercise weekly. Compared with a group of patients in sinus rhythm who underwent similar training, AF patients attained similar improvements in the 6-min walk test. After a median follow-up of 2.6 years, AF status was found to not be significantly associated with mortality or hospitalizations.
Exercise training (3,4) can have an antiarrhythmic effect from bouts of AF (5), likely due to a consequent decrease in sympathetic “tone.” In such cases, many individuals may need less therapy or a decreased dose of therapy for their AF. Patients with AF who undergo exercise training are reported to have improved quality of life to those with normal rhythm, as indicated by standard depression scores (6). Recent data also reveal that nonpermanent AF subjects who have exercise training had reduced short-term arrhythmic burden (7) (Table 1).
Overall, this excellent study by Luo et al. (2) strongly supports the role of exercise/physical activity in the management of subjects with both heart failure and AF. In general, more exercise time should be recommended, ideally by increasing exercise to most days each week. Modalities can include walking (treadmill may substitute), cycling (both arm and leg), elliptical trainer (arm and leg), swimming, pool walking, and other exercise that may be available in a health club or suggested by a physical training expert.
As our population ages, both heart failure and AF are more often present in the same individual. AF may be intermittent, and often a long-term or 24-h electrocardiogram recording is needed to document its occurrence.
Anticoagulation is indicated in patients with AF when there are no contraindications. It is clinically appropriate to prevent embolic events and is usually done with oral preparations. However, in the aging population, care must be taken to provide proper dosing to prevent side effects of bleeding and bruising, and ensure patient adherence to therapy.
↵∗ Editorials published in the Journal of the American College of Cardiology reflect the views of the authors and do not necessarily represent the views of JACC or the American College of Cardiology.
Dr. Fletcher has reported that he has no relationships relevant to the contents of this paper to disclose. P.K. Shah, MD, served as Guest Editor-in-Chief for this paper. Nanette K. Wenger, MD, served as Guest Editor for this paper.
- 2017 American College of Cardiology Foundation
- Pardaens K.,
- Van Cleemput J.,
- Vanhaecke J.,
- Fagard R.H.
- Luo N.,
- Merrill P.,
- Parikh K.S.,
- et al.
- Marseth B.,
- Graff-Iversen S.,
- Jacobsen B.K.,
- et al.
- Fletcher G.,
- Ades P.A.,
- Kligfield P.,
- et al.