We recommend in patients with HF and AF that the ventricular rate be controlled at rest and during exercise (Recommendation Strong, Quality Moderate).

We recommend that restoration and maintenance of sinus rhythm not be performed routinely (Recommendation Strong, Quality High).

We recommend beta-blockers for rate control particularly in those with HF-REF (Recommendation Strong, Quality Moderate).

We recommend beta-blockers combined with digoxin for uncontrolled ventricular rates on beta-blocker therapy at optimal dose alone (Recommendation Strong, Quality Moderate).

We recommend rate-limiting CCB be considered for rate control in HF-PEF (Recommendation Weak, Quality Low).

We recommend the use of antiarrhythmic therapy to achieve and maintain sinus rhythm, if rhythm control is indicated, be restricted to amiodarone (Recommendation Strong, Quality Moderate).

We recommend oral anticoagulation for AF in HF patients deemed high risk for stroke unless contraindicated as per current AF guidelines, and not to co-administer with antiplatelet agents unless the latter are needed for other indications (Recommendation Strong, Quality High).

Values and Preferences These recommendations are based on an understanding that the management of HF patients with AF should be individualized with respect to the need to identify precipitating factors, to assess the risk of therapy such as the development of bradycardia and proarrhythmia with antiarrhythmic agents and the bleeding risk of systemic anticoagulation.