Prevention of AF: new recommendations from the NHLBI

An expert panel convened by the National Heart, Lung, and Blood Institute (NHLBI) has identified knowledge gaps and developed research recommendations¹. They are summarised here.

• Enhance understanding of the epidemiology of AF. The pathology of the age-related increase in AF is unknown; it is not possible to predict an individual’s risk of developing AF; and the contributions of genetic factors are not understood.
• Improve detection of AF. Atrial fibrillation is frequently asymptomatic, and often detected only incidentally by pulse assessment or ECG screening. Therefore, the true prevalence is unknown, and is almost certainly underestimated.
• Improve non-invasive modalities for identifying key components of the cardiovascular remodelling that promotes AF. These would include methods to detect atrial fibrosis, electrical remodelling, inflammation and altered autonomic tone.
• Develop additional animal models of AF. For instance, there is a lack of animal models of age-related AF, and AF associated with hypertension.
• Specify ascertainment of symptomatic and asymptomatic AF as an end point in clinical cardiovascular trials.
• Conduct studies of prevention of recurrent AF. The most feasible strategy may be secondary intervention studies in patients with an initial episode of AF to prevent recurrent AF and to examine morbidity (heart failure, stroke) and mortality end points. Potential interventions might include RAAS inhibition, statins, beta blockers, omega-3 fatty acids, aggressive risk factor modification and anti-inflammatory strategies. The results of secondary prevention studies may be used to inform future primary prevention studies.

Reference

Benjamin EJ, Chen P-S, Bild DE et al. Prevention of atrial fibrillation. Report from a National Heart, Lung, and Blood Institute workshop. Circulation 2009; 119: 606-18.