Management of atrial fibrillation and heart failure in outpatient settings

Atrial fibrillation (AF) and heart failure (HF) have a highly interconnected relationship with similar risk factors and shared pathophysiology. They often occur together and are associated with increased morbidity and mortality. Unfortunately, the presence of one condition has implications for the treatment of the other. Guidelines exist for each disease, however, do not provide clarity when treating the conditions together. Due to the complex nature of the combined diseases, management requires a systematic and collaborative approach in primary care settings. The integrative review seeks to explore the following question, “How can the nurse practitioner (NP) best manage HF patients with AF in outpatient settings to help reduce the burden on the healthcare system?” A comprehensive search of the literature was undertaken and 20 articles were selected based on the inclusion criteria. The review findings provide insight into the diverse treatment options available to persons living with concomitant AF and HF. From the literature, catheter ablation, an invasive and specialized procedure, emerged as a superior treatment strategy for patients with combined AF and HF, particularly when compared the pharmacotherapy of rate and/or rhythm control. The management of AF in the setting of HF requires a collaborative approach between primary care providers (PCP) as well as specialists that are able to help manage the population of interest, such as cardiologist and electrophysiologists. Recommendations for practice, education, research, and policy have been made to support the role of PCPs, including NPs, in the management of AF in the HF population.