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3.5 Adverse events associated with AF Atrial fibrillation is associated with a range of serious adverse events (Figure 1) (see Supplementary data online, Additional Evidence Table S2). Patients with AF also have high rates of hospitalization and complications from coexisting medical conditions. The most common non-fatal outcome in those with AF is heart failure, occurring in around half of patients over time. Patients with AF have a four- to fivefold increase in the relative risk (RR) of heart failure compared with those without AF, as demonstrated in two meta-analyses (RR, 4.62; 95% CI, 3.13–6.83 and RR, 4.99; 95% CI, 3.0–8.22).68,69 The next most common adverse impacts from AF are ischaemic stroke (RR, 2.3; 95% CI, 1.84–2.94), ischaemic heart disease (RR, 1.61; 95% CI, 1.38–1.87), and other thromboembolic events.69–71 The latter typically include arterial thromboembolic events (preferred to the term systemic), although venous thromboembolism is also associated Patient symptoms Adverse outcomes Healthcare and society A t r i a l fi b r il l a t i o n I m p a c t a n d o u t c o m e s Palpitations Shortness of breath Fatigue Chest pain Dizziness Poor exercise capacity Fainting (syncope) Anxiety Depressed mood Disordered sleep Recurrent hospitalization Heart failure Ischaemic stroke Thromboembolism Cognitive decline and vascular dementia Depression Impaired quality of life Death Increasing prevalence High economic cost Impact on individuals, families and communities Doubling of AF 2010 2060 Lifetime risk 1 in 5 1 in 3 1–2% of healthcare expenditure Figure 1 Impacts and outcomes associated with clinical AF. AF, atrial fibrillation. Table 7 The modified European Heart Rhythm Association (mEHRA) symptom classification Score Symptoms Description 1 None AF does not cause any symptoms 2a Mild Normal daily activity not affected by symptoms related to AF 2b Moderate Normal daily activity not affected by symptoms related to AF, but patient troubled by symptoms 3 Severe Normal daily activity affected by symptoms related to AF 4 Disabling Normal daily activity discontinued © ESC 2024 AF, atrial fibrillation. ESC Guidelines 3329 Downloaded from academic.oup.com/eurheartj/article/45/36/3314/7738779 by guest on 07 October 2026