{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T10:37:13Z","timestamp":1780051033556,"version":"3.53.1"},"reference-count":30,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2025,11,24]],"date-time":"2025-11-24T00:00:00Z","timestamp":1763942400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Polish Cardiac Society","award":["CRU 0120-KCKB-2023"],"award-info":[{"award-number":["CRU 0120-KCKB-2023"]}]},{"DOI":"10.13039\/501100006334","name":"Jan Kochanowski University","doi-asserted-by":"publisher","award":["SUPB.RN.25.030"],"award-info":[{"award-number":["SUPB.RN.25.030"]}],"id":[{"id":"10.13039\/501100006334","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Heart failure (HF) and atrial fibrillation (AF) often coexist, and this has a major impact on prognosis. Only a limited amount of data is available on the effect of integrated strategies to improve prognosis in patients with HF and AF. We aimed to evaluate the association between HF subtype, HF optimal medical therapy (OMT), adherence to the Atrial Fibrillation Better Care (ABC) pathway, and all-cause death. Methods: Hospitalized patients and outpatients were enrolled in the Heart failuRe ObsErvational Study, which is a prospective, multicenter cohort study, between April 2022 and January 2024. Our analysis included patients with both HF and AF, who were divided into three groups: ABC + OMT, noABC + OMT, and noABC + noOMT. Results: A total of 627 patients, of whom 51.7% had HF with reduced ejection fraction, were included in this study. Direct oral anticoagulants were prescribed to 70.8% of patients, and 71.6% of these received the recommended doses. The patients were divided into the following groups: 49.8% were assigned to the ABC + OMT group, 25.2% to the noABC + OMT group, and 25% to the noABC + noOMT group. All-cause death occurred in 19.5% of patients. OMT compliance was associated with lower risk of all-cause death (HR0.61, 95% CI 0.42\u20130.9, p = 0.01), whereas management compliant with the ABC pathway was not (HR0.74, 95% CI 0.51\u20131.09, p = 0.12). In the ABC + OMT group, the risk of all-cause death was lower than in the noABC + noOMT group (HR0.60, 95% CI 0.39\u20130.92, p = 0.02). Conclusions: Integrated treatment strategies were implemented in half of the population with HF and AF, and this was associated with better long-term prognosis compared with patients who did not receive a complex treatment strategy.<\/jats:p>","DOI":"10.3390\/jcm14238338","type":"journal-article","created":{"date-parts":[[2025,11,25]],"date-time":"2025-11-25T17:31:34Z","timestamp":1764091894000},"page":"8338","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Integrated Care in Patients with Atrial Fibrillation and Optimal Medical Treatment for Heart Failure: Results from the Heart failuRe ObsErvational Study (HEROES)"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7619-8426","authenticated-orcid":false,"given":"Iwona","family":"Gorczyca-G\u0142owacka","sequence":"first","affiliation":[{"name":"Collegium Medicum, The Jan Kochanowski University, 25-317 Kielce, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-6850-9716","authenticated-orcid":false,"given":"Karolina","family":"Molenda","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Swietokrzyskie Psychiatry Center, 26-026 Morawica, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1219-2973","authenticated-orcid":false,"given":"Maciej","family":"Nadel","sequence":"additional","affiliation":[{"name":"2nd Department of Cardiology, Medical University of Lodz, 90-549 Lodz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8683-3913","authenticated-orcid":false,"given":"Agata","family":"Galas","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Internal Diseases, Military Institute of Medicine, 04-349 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1381-302X","authenticated-orcid":false,"given":"Agata","family":"Tymi\u0144ska","sequence":"additional","affiliation":[{"name":"First Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-3048-9786","authenticated-orcid":false,"given":"Katarzyna","family":"Byczkowska","sequence":"additional","affiliation":[{"name":"Department of Heart Failure, Transplantology and Mechanical Circulatory Support, National Institute of Cardiology, Alpejska 42, 04-628 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7493-3626","authenticated-orcid":false,"given":"Aleksander","family":"Siniarski","sequence":"additional","affiliation":[{"name":"Department of Coronary Disease and Heart Failure, Institute of Cardiology, Jagiellonian University Medical College, 31-202 Krakow, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Witold","family":"Furmanek","sequence":"additional","affiliation":[{"name":"Institute of Heart Diseases, Wroclaw Medical University, 50-566 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7019-1928","authenticated-orcid":false,"given":"Adrian","family":"Stefa\u0144ski","sequence":"additional","affiliation":[{"name":"Department of Hypertension and Diabetology, Faculty of Medicine, Medical University of Gdansk, 80-214 Gdansk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1409-4362","authenticated-orcid":false,"given":"Beata","family":"Wo\u017cakowska-Kap\u0142on","sequence":"additional","affiliation":[{"name":"Collegium Medicum, The Jan Kochanowski University, 25-317 Kielce, Poland"},{"name":"1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Center, 25-736 Kielce, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominika","family":"Klimczak-Tomaniak","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hypertension and Internal Medicine, Medical University of Warsaw, 03-258 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0256-0813","authenticated-orcid":false,"given":"Robert","family":"Morawiec","sequence":"additional","affiliation":[{"name":"2nd Department of Cardiology, Medical University of Lodz, 90-549 Lodz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"701","DOI":"10.33963\/v.phj.105590","article-title":"Atrial fibrillation in patients with heart failure with reduced, mildly reduced, and preserved ejection fraction: A report from the HEart failuRe ObsErvational Study (HEROES)","volume":"83","author":"Galas","year":"2025","journal-title":"Kardiol. Pol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1016\/j.jchf.2017.05.001","article-title":"Atrial Fibrillation in Heart Failure With Preserved, Mid-Range, and Reduced Ejection Fraction","volume":"5","author":"Sartipy","year":"2017","journal-title":"JACC Heart Fail."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"594","DOI":"10.1016\/j.jacep.2020.11.021","article-title":"Atrial Fibrillation Burden and Clinical Outcomes in Heart Failure: The CASTLE-AF Trial","volume":"7","author":"Brachmann","year":"2021","journal-title":"JACC Clin. Electrophysiol."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Wu, J., Tao, G., Xie, S., Yang, H., Qi, F., Bao, N., Li, Z., Chang, G., and Xiao, H. (2025). Prediction of three-year all-cause mortality in patients with heart failure and atrial fibrillation using the CatBoost model. BMC Cardiovasc. Disord., 25.","DOI":"10.1186\/s12872-025-04928-w"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"138","DOI":"10.20452\/pamw.3322","article-title":"Polish and European management strategies in patients with atrial fibrillation. Data from the EURObservational Research Programme-Atrial Fibrillation General Registry Pilot Phase (EORP-AF Pilot)","volume":"126","author":"Lenarczyk","year":"2016","journal-title":"Pol. Arch. Med. Wewn."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e033897","DOI":"10.1161\/JAHA.123.033897","article-title":"Heart Failure-Related Death in Subjects With Atrial Fibrillation in the United States, 1999 to 2020","volume":"13","author":"Zuin","year":"2024","journal-title":"J. Am. Heart Assoc."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1372","DOI":"10.1093\/eurjpc\/zwae185","article-title":"Prognosis and treatment strategies for atrial fibrillation in heart failure with mildly reduced ejection fraction","volume":"31","author":"Schupp","year":"2024","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"3599","DOI":"10.1093\/eurheartj\/ehab368","article-title":"2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure","volume":"42","author":"McDonagh","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1038\/nrcardio.2017.153","article-title":"The ABC pathway: An integrated approach to improve AF management","volume":"14","author":"Lip","year":"2017","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1055\/a-1515-9630","article-title":"Adherence to the \u201catrial fibrillation better care\u201d pathway in patients with atrial fibrillation: Impact on clinical outcomes-a systematic review and meta-analysis of 285,000 patients","volume":"122","author":"Romiti","year":"2022","journal-title":"Thromb. Haemost."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1093\/eurheartj\/ehaa612","article-title":"2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS)","volume":"42","author":"Hindricks","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_12","first-page":"20","article-title":"2021 focused update consensus guidelines of the Asia Pacific Heart Rhythm Society on stroke prevention in atrial fibrillation: Executive summary","volume":"22","author":"Chao","year":"2021","journal-title":"Thromb. Haemost."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"321","DOI":"10.33963\/v.phj.103877","article-title":"Rationale, objectives, and design of the HEart failuRe ObsErvational Study of the Polish Cardiac Society (HEROES)","volume":"83","author":"Morawiec","year":"2025","journal-title":"Kardiol. Pol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"3627","DOI":"10.1093\/eurheartj\/ehad195","article-title":"2023 Focused Update of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure","volume":"44","author":"McDonagh","year":"2023","journal-title":"Eur. Heart J."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"103182","DOI":"10.1016\/j.ctim.2025.103182","article-title":"The effectiveness and safety of integrative medicine for chronic heart failure: An umbrella review","volume":"91","author":"Chua","year":"2025","journal-title":"Complement. Ther. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e037290","DOI":"10.1161\/JAHA.124.037290","article-title":"Chronotropic Incompetence and Cardiovascular Outcomes in Patients With Heart Failure With Preserved Ejection Fraction","volume":"14","author":"Lin","year":"2025","journal-title":"J. Am. Heart Assoc."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"euae237","DOI":"10.1093\/europace\/euae237","article-title":"Components of the Atrial fibrillation Better Care pathway for holistic care of patients with atrial fibrillation: A win-ratio analysis from the COOL-AF registry","volume":"26","author":"Krittayaphong","year":"2024","journal-title":"Europace"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"100507","DOI":"10.1016\/j.lansea.2024.100507","article-title":"Phenotypes of South Asian patients with atrial fibrillation and holistic integrated care management: Cluster analysis of data from KERALA-AF Registry","volume":"31","author":"Chen","year":"2024","journal-title":"Lancet Reg. Health Southeast Asia"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e030499","DOI":"10.1161\/JAHA.123.030499","article-title":"Optimal Medical Therapy for Heart Failure and Integrated Care in Patients With Atrial Fibrillation: A Report From the ESC-EHRA EORP Atrial Fibrillation Long-Term General Registry","volume":"14","author":"Bonini","year":"2025","journal-title":"J. Am. Heart Assoc."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"187","DOI":"10.20452\/pamw.15146","article-title":"Adherence to the ABC (Atrial fibrillation Better Care) pathway in the Balkan region: The BALKAN-AF survey","volume":"130","author":"Simovic","year":"2020","journal-title":"Pol. Arch. Intern. Med."},{"key":"ref_21","first-page":"16619","article-title":"Does atrial fibrillation still increase the risk of death? One-year follow-up results of the NOMED-AF study","volume":"134","author":"Mitrega","year":"2024","journal-title":"Pol. Arch. Intern. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1093\/europace\/euaa274","article-title":"Relation of outcomes to ABC (Atrial Fibrillation Better Care) pathway adherent care in European patients with atrial fibrillation: An analysis from the ESC-EHRA EORP Atrial Fibrillation General Long-Term (AFGen LT) Registry","volume":"23","author":"Proietti","year":"2021","journal-title":"Europace"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1016\/S0140-6736(20)30748-0","article-title":"Estimating lifetime benefits of comprehensive disease-modifying pharmacological therapies in patients with heart failure with reduced ejection fraction: A comparative analysis of three randomised controlled trials","volume":"396","author":"Vaduganathan","year":"2020","journal-title":"Lancet"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1355","DOI":"10.1007\/s00392-024-02498-z","article-title":"Modern heart failure treatment is superior to conventional treatment across the left ventricular ejection spectrum: Real-life data from the Swedish Heart Failure Registry 2013\u20132020","volume":"113","author":"Pivodic","year":"2024","journal-title":"Clin. Res. Cardiol."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Matteucci, A., Pandozi, C., Bonanni, M., Mariani, M.V., Sgarra, L., Nesti, L., Pierucci, N., La Fazia, V.M., Lavalle, C., and Nardi, F. (2025). Impact of empagliflozin and dapagliflozin on sudden cardiac death: A systematic review and meta-analysis of adjudicated randomized evidence. Heart Rhythm, in press.","DOI":"10.1016\/j.hrthm.2025.09.023"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Kongmalai, T., Hadnorntun, P., Leelahavarong, P., Kongmalai, P., Srinonprasert, V., Chirakarnjanakorn, S., Chaikledkaew, U., McKay, G., Attia, J., and Thakkinstian, A. (2023). Comparative cardiovascular benefits of individual SGLT2 inhibitors in type 2 diabetes and heart failure: A systematic review and network meta-analysis of randomized controlled trials. Front. Endocrinol., 14.","DOI":"10.3389\/fendo.2023.1216160"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"537","DOI":"10.33963\/KP.a2023.0110","article-title":"Pharmacotherapy of heart failure A.D. 2023. Expert opinion of Working Group on Cardiovascular Pharmacotherapy, Polish Cardiac Society","volume":"81","author":"Kasprzak","year":"2023","journal-title":"Kardiol. Pol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"3314","DOI":"10.1093\/eurheartj\/ehae176","article-title":"2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS)","volume":"45","author":"Rienstra","year":"2024","journal-title":"Eur. Heart J."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2893","DOI":"10.1093\/eurheartj\/ehw210","article-title":"2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS","volume":"37","author":"Kirchhof","year":"2016","journal-title":"Eur. Heart J."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"15","DOI":"10.12968\/hmed.2024.0929","article-title":"A Holistic Approach to Improving Outcomes in Atrial Fibrillation: The AF-CARE Pathway","volume":"86","author":"Griffin","year":"2025","journal-title":"Br. J. Hosp. Med."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/23\/8338\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,25]],"date-time":"2025-11-25T17:33:57Z","timestamp":1764092037000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/23\/8338"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,24]]},"references-count":30,"journal-issue":{"issue":"23","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["jcm14238338"],"URL":"https:\/\/doi.org\/10.3390\/jcm14238338","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,24]]}}}