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5. [C] Comorbidity and risk factor management A broad array of comorbidities are associated with the recurrence and progression of AF. Managing comorbidities is also central to the success of other aspects of care for patients with AF, with evidence available for hypertension, heart failure, diabetes mellitus, obesity, and sleep apnoea, along with lifestyle changes that improve physical activity and reduce alcohol intake (see Supplementary data online, Additional Evidence Table S4). Identification and treatment of these comorbidities and clusters of risk factors form an important part of effective AF-CARE (Figure 8), with the evidence outlined in the rest of this section highlighting where management can improve patient outcomes or prevent AF recurrence. Many of these factors (and more) are also associated with incident AF (see Section 10).

Focus on key risk factors

Provide information without overloading

Suggested approach and targets

Setting individual targets for comorbidities and risk factors

Key targets Behavioural

change

Achievable

targets

Identify and actively manage all risk factors and comorbidities

(Class I)

Blood pressure treatment with target 120–129 mmHg / 70–79 mmHg in most adults (or as low as reasonably achievable) (Class I)

Effective glycaemic control with diet/medication(s)

(Class I)

Weight loss programme if overweight /obese,

with 10% or more weight loss

(Class I)

Management of obstructive sleep apnoea to minimize

apnoeic episodes

(Class IIb)

Tailored exercise programme aiming for regular

moderate/vigorous activity

(Class I)

Reduce alcohol consumption to 3 or less standard

drinks per week

(Class I)

Shared decision-making

Hypertension

Sleep apnoea

Heart failure

Diabetes

Obesity

Integrated management

Physical activity

Alcohol intake Optimize with diuretics to alleviate congestion appropriate, medical therapy for reduced LVEF, and SGLT2 inhibitors for all LVEF

(Class I)

Figure 8 Management of key comorbidities to reduce AF recurrence. LVEF, left ventricular ejection fraction; SGLT2, sodium-glucose cotransporter-2. Downloaded from academic.oup.com/eurheartj/article/45/36/3314/7738779 by guest on 07 October 2026