What does this research mean for the field?

In elderly heart failure patients, treatment with ≥3 guideline-directed medical therapies reduced the incidence of new-onset atrial fibrillation by 77% (HR 0.23, P=0.04). Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

What question did this study set out to answer?

To examine the association between contemporary guideline-directed medical therapy (GDMT) and the incidence of new-onset atrial fibrillation in elderly heart failure patients.

February 8, 2026European Heart Journal

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

Q: What are the key findings of this study?

In elderly HF patients, treatment with ≥3 GDMT drugs reduced new-onset AF incidence by 77% (HR 0.23, P=0.04) and HF rehospitalization by 78% (HR 0.22, P<0.01).

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Key result

≥3 GDMT drugs are linked to ~77% lower new-onset AF and HF rehospitalization risk in elderly patients.

HR 0.23
P=0.04
HR 0.22
P<0.01

Why the study?

The efficacy of contemporary GDMT for heart failure in reducing new-onset AF is not known in elderly heart failure patients.

Does treatment with ≧3 GDMT classes reduce the incidence of new-onset atrial fibrillation in elderly patients (>75 years) with HFrEF and HFmrEF?

Key Points

To examine the association between contemporary guideline-directed medical therapy (GDMT) and the incidence of new-onset atrial fibrillation in elderly heart failure patients.
Retrospective study of 203 elderly heart failure patients admitted for decompensated heart failure
Patients divided into two groups based on GDMT regimen adherence (≤2 vs. ≥3 therapies)
Long-term incidence of new-onset atrial fibrillation compared between groups
Significantly fewer new-onset atrial fibrillation cases in the ≥3 GDMT regimen group (HR 0.23, P=0.04)
Reduced re-hospitalization for heart failure in the ≥3 GDMT regimen group (HR 0.22, P<0.01)
New-onset atrial fibrillation linked to higher re-hospitalization rates (HR 5.65, P<0.001)

Structured PICO

Does treatment with ≧3 GDMT classes reduce the incidence of new-onset atrial fibrillation in elderly patients (>75 years) with HFrEF and HFmrEF?

Population

203 elderly patients (>75 years old) with HFrEF and HFmrEF without a history of atrial fibrillation, admitted for decompensated heart failure between 2015 and 2022.

Intervention

Treatment with ≧3 guideline-directed medical therapy (GDMT) regimen classes (from RASi/ARNI, β-blocker, MRA, SGLT2i) after discharge.

Comparator

Treatment with ≦2 guideline-directed medical therapy (GDMT) regimen classes after discharge.

Outcome

Long-term incidence of new-onset atrial fibrillation.hard clinical

In elderly patients with HFrEF and HFmrEF, adherence to 3 or more GDMT classes is associated with a significantly lower risk of new-onset atrial fibrillation and subsequent heart failure rehospitalization.

Implication

May support GDMT optimization in elderly HF; extends observational consensus on AF prevention but leaves causality open.

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, P<0.01). In addition, the new-onset AF was significantly associated with re-hospitalization for HF in the studied patients (HR 5.65, P<0.001, 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

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Cite This Study

Mukai et al. (2025) studied this question. In elderly HF patients, treatment with ≥3 GDMT drugs reduced new-onset AF incidence by 77% (HR 0.23, P=0.04) and HF rehospitalization by 78% (HR 0.22, P<0.01).

synapsesocial.com/papers/698827e20fc35cd7a8846dc2 https://doi.org/10.1093/eurheartj/ehaf784.425