Reply to: Atrial fibrillation and heart failure and the risk of false dichotomies.

We thank Dr. Jolobe for the comments on our paper regarding NTproBNP to rule-out heart failure among patients with atrial fibrillation [1,2]. Dr. Jolobe raises two concerns: the potential misclassification of patients due to the definition of heart failure used in our study and the presence of patients in our cohort with comorbidities associated with high NT-proBNP levels. study as an ejection fraction below 40% is dichotomous and may be concriteria for diagnosing congestive heart failure. Although these clinical scales may identify patients with reduced ejection fraction these scales have varying sensitivity and specificity and may also not identify patients with low ejection fraction [3]. Importantly, there is a broad contemporary consensus that heart failure with reduced ejection fraction is defined as an ejection fraction below 40% similar to the definition used in our study [4,5]. antagonists.