Liver-metabolic disease is linked to increased heart failure risk in older adults with atrial fibrillation, according to a new study.

To address this, a team of researchers from Korea University, comprising Ms. Jeongin Lee and Mr. Sangwook Cheon, led by Professor Seogsong Jeong, conducted the nationwide study. They analysed data from 7,543 adults aged 60 and older with atrial fibrillation and found that steatotic liver disease significantly increased the likelihood of developing heart failure over a follow-up period of around nine years.

The study, published in the European Journal of Heart Failure, examined different subtypes of steatotic liver disease, including metabolic dysfunction-associated SLD, metabolic dysfunction-associated SLD with increased alcohol intake, and alcohol-related liver disease.

Across all subtypes, patients with liver disease had a higher risk of heart failure compared to those without. The risk followed a clear gradient, with the lowest increase seen in metabolic dysfunction-associated SLD, rising further in patients with combined metabolic and alcohol-related disease, and highest in those with alcohol-related liver disease.

The findings suggest that both metabolic dysfunction and alcohol exposure contribute to worsening cardiovascular outcomes in patients with atrial fibrillation.

Seogsong Jeong, professor at Korea University, said: “Fatty liver disease develops through different metabolic and alcohol-related pathways, and these differences may affect how AFib progresses to HF. Our study aimed to better understand this relationship.”

The researchers also identified dose-response relationships between heart failure risk and markers such as fatty liver index, alcohol intake and fasting glucose levels. This indicates that increasing metabolic and liver-related burden may directly translate into higher cardiovascular risk.

The results add to growing evidence around the so-called liver–heart axis, where liver dysfunction contributes to systemic inflammation, vascular stress and cardiac remodelling. These mechanisms are increasingly being recognised as important drivers of disease progression in atrial fibrillation.

While atrial fibrillation is already a major risk factor for heart failure, affecting more than 64 million people worldwide, the study suggests that liver health may be an under-recognised contributor to outcomes in older patients.

The findings could have implications for clinical practice, particularly as rates of obesity, metabolic syndrome and alcohol-related liver disease continue to rise. Current risk assessment in atrial fibrillation largely focuses on cardiovascular factors, but the data suggest that incorporating liver-metabolic markers could improve patient stratification.

Seogsong Jeong said: “Early detection and management of liver–metabolic dysfunction may help reduce the risk of HF in patients with AFib.”

The study points towards a need for more integrated approaches to cardiometabolic care, including closer monitoring of patients with both atrial fibrillation and liver disease. Lifestyle interventions such as weight management, diabetes control and reduced alcohol intake may also play a role in lowering risk.

Although further research is needed to determine how best to apply these findings in clinical settings, the data highlight the importance of looking beyond the heart when managing atrial fibrillation in ageing populations.