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Despite advances in HF management, AF remains a critical comorbidity that worsens outcomes and requires ad hoc treatment strategies, increasing the risk of non-adherence and side effects. While rhythm control strategies in AF have gained attention for their prognostic benefits in HF, the pharmacological treatment of HF in patients with AF, including the benefit of rhythm versus rate control, remains underexplored. The relationship between HF and AF lacks sufficient evidence and targeted research to assess the optimal treatment strategies. This narrative review critically examines current HF pharmacotherapy in the context of AF, focusing on the four cornerstone treatments and modifiers of prognosis for HF with reduced ejection fraction: beta-blockers, angiotensin-converting enzyme inhibitors\/angiotensin receptor blockers\/sacubitril-valsartan, aldosterone antagonists, and sodium\u2013glucose co-transporter 2 inhibitors. Although these therapies are well-established in HF patients, their efficacy in patients with concomitant AF requires further prospective investigation. The unique challenges posed by AF, including arrhythmia-induced remodelling and cardiomyopathy, necessitate a more individually tailored treatment. We also highlight critical knowledge gaps and the need for dedicated clinical trials specifically assessing HF therapies in AF subgroups, such as paroxysmal, long-standing persistent and permanent AF, and the benefit of heart rate and rhythm control strategies. The future of precision medicine in HF-AF management lies in bridging these evidence gaps through targeted research and interdisciplinary collaboration.<\/jats:p>","DOI":"10.1002\/ejhf.70069","type":"journal-article","created":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T10:35:56Z","timestamp":1761129356000},"page":"2198-2210","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["<i>European Journal of Heart Failure<\/i>\n                    Consensus Statement. Heart Failure Pharmacotherapy for Patients with Heart Failure with Reduced Ejection Fraction and Concomitant Atrial Fibrillation: Review of Evidence and Call to Action"],"prefix":"10.1093","volume":"27","author":[{"given":"Mark","family":"Luedde","sequence":"first","affiliation":[{"name":"Medical Clinic I, Cardiology and Angiology, Justus-Liebig-University , Giessen ,","place":["Germany"]},{"name":"Cardiologicum Bremerhaven, Sanecum Group , Bremerhaven ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Agewall","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute , Stockholm ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Ambrosio","sequence":"additional","affiliation":[{"name":"Department of Medicine and CERICLET, University of Perugia School of Medicine , Perugia ,","place":["Italy"]},{"name":"Institute for Cardiovascular Research -INRC , Perugia ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antoni","family":"Bayes-Genis","sequence":"additional","affiliation":[{"name":"Heart Institute, Hospital Universitari Germans Trias I Pujol, CIBERCV , Badalona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudio","family":"Borghi","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, University of Bologna-IRCCS AOU S. 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Polytechnic University of Leiria , Leiria ,","place":["Portugal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Parker","sequence":"additional","affiliation":[{"name":"Cardiovascular Research Unit, University of Sheffield , Sheffield ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark C.","family":"Petrie","sequence":"additional","affiliation":[{"name":"School of Cardiovascular and Medical Sciences, University of Glasgow , Glasgow ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bianca","family":"Rocca","sequence":"additional","affiliation":[{"name":"Department of Medicine and Surgery, LUM University , Casamassima ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne Grete","family":"Semb","sequence":"additional","affiliation":[{"name":"Preventive Cardio-Rheuma clinic, Division of Research and Innovation, REMEDY Centre, Diakonhjemmet Hospital , 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Medicine, Universidad Complutense, Instituto de Investigaci\u00f3n Sanitaria Gregorio Mara\u00f1\u00f3n , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Metra","sequence":"additional","affiliation":[{"name":"Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia , Brescia ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"B\u00f6hm","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Innere Medizin III, HOMICAREM (HOMburg Institute for CArdioREnalMetabolic Medicine), Universit\u00e4tsklinikum des Saarlandes, Saarland University , Homburg\/Saar ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dobromir","family":"Dobrev","sequence":"additional","affiliation":[{"name":"Institute of Pharmacology, West-German Heart and Vascular Center, University Duisburg-Essen , Essen ,","place":["Germany"]},{"name":"Department of Medicine, Montreal Heart Institute and Universit\u00e9 de Montr\u00e9al , Montr\u00e9al, QC ,","place":["Canada"]},{"name":"Department of Integrative Physiology, Baylor College of Medicine , Houston, TX ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel","family":"Sossalla","sequence":"additional","affiliation":[{"name":"Medical Clinic I, Cardiology and Angiology, Justus-Liebig-University , Giessen ,","place":["Germany"]},{"name":"Medical Clinic I, Cardiology and Angiology, Justus-Liebig-University, Giessen and Department of Cardiology, Kerckhoff-Clinic\/DZHK , Bad Nauheim ,","place":["Germany"]},{"name":"Excellence Cluster Cardiopulmonary Insitute (CPI) , Klinikstra\u00dfe 33, Giessen 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