Introduction: The relationship between smoking and heart disease has been frequently reported. Therefore, we aimed to explore the association between smoking initiation and atrial fibrillation. Methods: Genetic association data pertaining to smoking initiation and atrial fibrillation were...

Heart failure and diabetes mellitus frequently coexist. These two conditions mutually exacerbate each other, significantly increasing the risks of cardiovascular death and rehospitalization. Sodium–glucose cotransporter 2 inhibitors have demonstrated unexpected and profound cardioprotective effects beyond glycemic control in cardiovascular outcome trials, driving a paradigm shift in heart failure treatment. A literature search was conducted to identify key studies, including landmark randomized controlled trials, meta-analyses, and real-world evidence studies. The findings show that sodium–glucose cotransporter 2 inhibitors exert cardioprotective effects through multiple mechanisms including hemodynamic optimization, myocardial energy metabolism reprogramming, ionic homeostasis regulation, anti-inflammatory and antioxidant effects, and renoprotection. Real-world evidence studies validate these findings across broader populations. Clear benefits are also observed in special populations, including elderly and frail patients and patients with cancer therapy-related cardiac dysfunction. Regarding safety, although increased risks of genital infections and volume depletion exist, these are generally manageable, while risks of acute kidney injury are significantly reduced, indicating favorable overall tolerability. In sum, sodium–glucose cotransporter 2 inhibitors have established themselves as a cornerstone therapy for patients with heart failure and type 2 diabetes. Future research should focus on elucidating direct cardiac mechanisms, optimizing implementation in routine care, exploring novel combination strategies, and advancing precision medicine-guided individualized treatment. Type 1 diabetes, by contrast, remains a distinct research question and requires dedicated efficacy and safety studies, with particular attention to ketoacidosis risk.

Aim: This study developed two nomograms to predict the incidence of acute heart failure (AHF) in patients of atrial fibrillation (AF) and evaluated the predictive value of the nomograms. Method: 18179 patients of AF from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database were analysed. The patients were randomly divided into two groups in a seven-to-three ratio to form a training cohort (n = 12725) and a validation cohort (n = 5454). Least absolute shrinkage and selection operator (LASSO) regression analyses were used to identify associated risk variables. Two nomograms were established to predict the rate of AHF in patients of AF for use by patients and clinicians, respectively. The new models were assessed in terms of the concordance index (C-index), the area under the curve (AUC) of receiver operating characteristic (ROC) analysis, calibration curve, and decision curve analysis (DCA). Results: Least absolute shrinkage and selection operator (LASSO) regression analysis identified seven potential predictors of acute heart failure in nomogram 1 and three potential predictors in nomogram 2. Multivariate logistic regression analysis was used to evaluate the effects of these predictors and create final models. The concordance index values were 0.768 and 0.696, respectively. The areas under the curves for the training and validation sets in nomogram 1 were 0.768 and 0.763, respectively. The areas under the curves for the training and validation sets in nomogram 2 were 0.696 and 0.692, respectively. Conclusion: The age, respiratory rate, fluid management, mean corpuscular hemoglobin concentration (MCHC), bicarbonate, blood urea nitrogen (BUN) and chloride were identified as predictors of the development of acute heart failure in patients with atrial fibrillation in nomogram 1. The charlson score, lods score and sapsII score were identified as predictors of the development of acute heart failure in nomogram 2. Our nomograms are reliable convenient approaches for predicting acute heart failure in patients with atrial fibrillation.

Frailty is highly prevalent in older patients with atrial fibrillation (AF), complicating anticoagulation decisions due to the dual elevation of both stroke and bleeding risks. This narrative review provides a framework to guide these decisions. We propose a three-step approach: (1) systematically assess frailty using a validated tool to stratify patients into risk categories; (2) translate this stratification into therapeutic choices, generally favoring direct oral anticoagulants (DOACs) over warfarin, with data suggesting a favorable bleeding profile for apixaban in frail populations, but routine switching to a DOAC should be avoided in frail patients who are stable on warfarin with good time in therapeutic range; and (3) consider specific alternatives, such as very-low-dose edoxaban, for patients with severe frailty or a prohibitive bleeding risk, while noting that this strategy should be applied within its specific regulatory and clinical context. The net clinical benefit of anticoagulation, defined as the absolute risk reduction in ischemic stroke offset by the absolute risk increase in major bleeding, diminishes with increasing frailty severity and may vanish in the most severe stages. Clinical decisions must therefore integrate dynamic frailty reassessment, multidisciplinary collaboration, and patient preferences. This review underscores a shift from purely guideline-driven to patient-value-driven individualized anticoagulation strategies in frail older adults with AF.