The contemporary guideline-directed medical therapy (GDMT) for heart failure is associated with a reduced incidence of new-onset atrial fibrillation in the elderly patients

Abstract Backgrounds We previously reported that contemporary guideline-directed medical therapy (GDMT) for heart failure (HF) (RASi/ARNI + β-blocker + MRA + SGLT2i) reduces the incidence of new-onset of atrial fibrillation (AF). However, the efficacy is not yet known in the elderly HF patients. Methods and Results We retrospectively studied the long-term incidence of new-onset AF in HFrEF and HFmrEF elderly patients (75 years old) without history of AF (n=203) admitted to our hospital due to decompensated HF between 2015 and 2022. Patients were divided into 2 groups; patients treated with ≦2 GDMT regimen (n=130) and patients with ≧3 GDMT regimen (n=73) after discharge. The incidence of new-onset AF was significantly fewer in the ≧3 GDMT regimen group (HR 0.23, P=0.04, Figure A). In addition, re-hospitalization for HF was significantly fewer in the ≧3 GDMT regimen group (HR 0.22, P0.01). In addition, the new-onset AF was significantly associated with re-hospitalization for HF in the studied patients (HR 5.65, P0.001, Figure B). Conclusion The present study demonstrated that even in the elderly HF patients, the contemporary GDMT for HF was associated with a reduced incidence of new-onset AF, which might be relevant to a reduced re-hospitalization rate in the proactively treated patients.Figure