AFib and Heart Failure: Two Peas in a Pod? 

In one of our community posts about heart failure (HF) associated comorbid conditions, many people expressed the association between atrial fibrillation (AFib) and HF.

Comorbidity means having more than one condition in the same person at the same time. It can be incredibly stressful and scary to manage two conditions simultaneously. If you have just recently been diagnosed with one of these conditions, the following article will outline the association between them and highlight how common this association really is.

What is Afib?

For people with HF but without Afib, Afib may be an unfamiliar condition. However, Afib is very common: there are approximately 2.3 million Americans who are affected by this condition.¹ Afib is a condition used to describe irregular heart rhythm. These arrhythmias can lead to stroke, blood clots, and sometimes, heart failure.

After the age of 40, 26% of men and 23% of women are expected to receive an Afib diagnosis.² That means that almost one in four men, or one in five women, you meet over the age of 40 have this condition.

The association

Afib and HF go hand-in-hand; in fact, having one of these conditions increases the risk of being diagnosed with the other.¹ In the well-known Framingham Heart Study, this association was shown:

• In people recently diagnosed with HF, 57% of them also had Afib, which was diagnosed prior to HF
• 37% of people just diagnosed with Afib had a prior history of HF

This demonstrates the comorbid nature of these two conditions. It was also found that more severe HF (for example, end-stage heart failure) was more likely to be correlated with an Afib diagnosis.²

Common risk factors

Afib and HF share similar risk factors. Some of these include:³

• High alcohol intake
• Obesity
• Diabetes
• High blood pressure
• Male sex
• Smoking
• Hyperthyroidism, a condition where the thyroid is overactive
• Genetic factors

Not all of these risk factors are modifiable. However, certain risk factors such as alcohol intake and smoking are behaviors that can be reduced to help lower heart risks.

Distinguishing symptoms

Symptoms of HF and Afib can usually be distinguished. For example, Afib usually manifests with the following symptoms:³

• Chest pain
• Dizziness
• Irregular heart beat

On the other hand, the following symptoms are more likely to occur in HF:³

• Weight gain, as a result of fluid accumulation
• Swelling in the lower extremities
• Shortness of breath
• Fatigue

Treatment

When someone has both Afib and HF, it is common that when one condition is exacerbated, the other condition gets worse as well.³

It is certainly a challenge to treat one of these conditions, let alone both. The treatment for each is distinct. For example, in Afib, the following approaches may be trialed in addition to anticoagulation (medication that reduces the risk of blood clots):

• Pacemaker insertion: a device is inserted in your body, which sends signals to the heart to control the heartbeat.
• Electrical cardioversion: an electric shock is sent to the heart to correct the rhythm.⁹
• Ablation: a scar is created to block off abnormal heart signals.¹⁰

Do you have both Afib and HF? Which one came first, and what are some challenges of managing both conditions?