Modern guidelines for the management of patients with atrial fibrillation and comorbid conditions: a literature review
DOI:
https://doi.org/10.14739/2310-1210.2025.6.336900Keywords:
atrial fibrillation, comorbid conditions, arterial hypertension, type 2 diabetes mellitus, obesity, heart failure, coronary artery disease, chronic kidney disease, obstructive sleep apnea, diagnosis, treatmentAbstract
Aim. To summarize and analyze current literature data on the management of patients with atrial fibrillation (AF) and comorbid conditions.
Materials and methods. A systematic analysis of scientific publications from databases including PubMed, Scopus, Web of Science, and Google Scholar was conducted for the period 2020–2025. Additionally, the latest clinical guidelines from the ESC (2024), AHA / ACC / HRS (2023), and Ukrainian national recommendations were reviewed. The selected sources focused on the diagnosis, treatment, and prevention of AF in patients with comorbid diseases. Only publications meeting the criteria of thematic relevance, full-text availability, and up-to-date clinical content were included.
Results. In most clinical cases, AF is a manifestation of a polymorbid condition, which significantly modifies its clinical course, increases the risk of complications, and reduces the effectiveness of both pharmacological and interventional therapies. Comorbidities such as arterial hypertension, coronary artery disease, heart failure, type 2 diabetes mellitus, chronic kidney disease, obesity, and obstructive sleep apnea are considered not only etiological factors of AF but also markers of overall cardiovascular risk and/or structural heart disease. Timely diagnosis of AF considering comorbid pathology and based on electrocardiographic, imaging, and clinical-laboratory parameters, combined with risk stratification using validated scales (CHA2DS2-VA, HAS-BLED, mEHRA, SAMe-TT2R2, etc.) is crucial for selecting an optimal therapeutic strategy and reducing complication rates. The 2024 ESC guidelines propose an integrated AF-CARE pathway for AF management, which includes not only rhythm control and anticoagulation therapy but also mandatory management of comorbid conditions, thus forming the foundation for preventing AF recurrence and progression.
Conclusions. Comorbid conditions significantly influence the prognosis of AF patients, the choice of treatment strategy, and its effectiveness. Early diagnosis, risk stratification, and targeted management of comorbidities, based on the AF-CARE approach, should be considered an integral part of comprehensive AF care, contributing to improved clinical outcomes, patient survival, and quality of life.
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