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New roadmap to improve AF management

The report from the 5th Atrial Fibrillation Network association (AFNET)/European Heart Rhythm Association (EHRA) consensus conference has been published recently in EP Europace,1 aiming to provide a roadmap to improve the quality of AF management.

The 5th AFNET/EHRA consensus conference was convened with the focus on “Understanding and eliminating inequalities and barriers that prevent optimal treatment of AF”. Professor Paulus Kirchhof, one of the conference organisers, board member of EHRA and speaker of the board of AFNET, explained: “We arranged this meeting with the aim to set out a roadmap for a tangible improvement of atrial fibrillation management. The outcome of the conference has been condensed into a set of recommendations and research priorities in AF.”

The report’s contributors agree that for successful AF therapy all patients should be involved in decisions about their care, and that they should be well informed. In order to achieve this, the authors recommend enhancing the publicly available information on AF, its complications, and the therapeutic options. Patient-focused initiatives such as the website for patients “AFib matters” (www.afibmatters.org) were considered very helpful, promoting patient engagement in the field of AF. Furthermore, patient-reported outcomes should be used to capture AF-related symptoms and patients’ experiences.

Adequate management of AF patients is complex. Professor Andreas Goette, board member of AFNET, explained: “Such AF care should ensure that evidence-based therapy is offered to all AF patients.” Therefore the AFNET/EHRA roadmap recommends a more structured approach led by interdisciplinary teams and suggests the development of patient-centered care plans for all AF patients.

Improving treatment

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Professor Paulus Kirchhof (conference organiser)

The AFNET/EHRA roadmap recommends the establishment of widespread screening for AF in those over the age of 65, or in populations at high risk, in order to make a timely diagnosis and treatment of AF possible. Strategies to minimise interruption of discontinuation of anticoagulant therapy need to be evaluated since anticoagulants are effective only if taken continuously.

AF ablation is an established AF treatment and hence offered in an increasing number of hospitals. The authors recommend development of standards to consistently measure the quality and success of AF ablation. Often ablation does not completely eliminate AF, and further trials are needed to identify the best rhythm control therapy in patients with recurrent AF after ablation.

Personalised AF management

Further research is required to better understand the underlying cellular and molecular mechanisms of AF. The experts suggest the evaluation of genetic factors, specific biomarkers and electrocardiogram (ECG) parameters to identify different subtypes of AF in individual patients in order to develop more targeted therapies. For example, new biomarkers or ECG information can be used to refine anticoagulation risk assessment individually for patients with an intermediate or low risk of stroke. Currently it is not clear whether this group of patients will benefit from anticoagulation therapy or not.

Professor A John Camm, president-elect of EHRA and co-organiser of the 5th AFNET/EHRA consensus conference, concluded: “We believe that the suggested research activities can help to optimise AF therapy and improve the outcomes of many AF patients in the world. There is an urgent need for long-term research funding to enable the implementation of appropriate studies.”

References

1. Kirchhof P et al. A roadmap to improve the quality of atrial fibrillation management: proceedings from the fifth Atrial Fibrillation Network/European Heart Rhythm Association consensus conference. Europace 2015. http://dx.doi.org/10.1093/europace/euv304

Published on: October 30, 2015

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ENDORSED BY

  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association
 

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