AFNET and EHRA lay out roadmap to improve AF management
At least 30 million people worldwide live with atrial fibrillation (AF). Despite improved treatment options AF patients still suffer strokes, heart failures, and premature deaths. The German Atrial Fibrillation Network association (AFNET) and the European Heart Rhythm Association (EHRA) initiated development of a roadmap to improve the quality of AF management. An international group of experts developed a set of initiatives and recommendations aimed at improving the care for AF patients. The report of the 5th AFNET/EHRA consensus conference is published online in the EP Europace journal today.
The 5th AFNET/EHRA consensus conference was convened with the focus on “Understanding and eliminating inequalities and barriers that prevent optimal treatment of atrial fibrillation”. Professor Paulus Kirchhof, one of the conference organizers, 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.”
Learning from our neighbours
Over seventy AF experts, representing an almost global community of AF professionals, participated in the conference and shared their experiences. “Given the wide global variety in healthcare structures, the different countries in the world can learn from each other and develop role models of excellent AF care. We hope that this roadmap created by specialists coming from different parts of the world will help to improve AF management in Europe and beyond.” observed Professor Gerhard Hindricks, president of EHRA.
Informed and involved patients
The experts agree that for successful AF therapy all AF patients should be involved in decisions about their care. It is imperative that the patients are well informed about AF. 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) developed in 5 European languages now and released by the European Heart Rhythm Association (EHRA) 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 AF treatment
Several millions of people in the world suffer from undiagnosed and therefore untreated AF, associated with high risk of strokes and death. 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 minimize 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.
Personalized 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 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-organizer of the 5th AFNET/EHRA consensus conference, concluded: “We believe that the suggested research activities can help to optimize 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.”
The conference was organized and co-financed by AFNET and EHRA. Industry participants paid an attendance fee.
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; doi:10.1093/europace/euv304
The Atrial Fibrillation Network association (AFNET) is an interdisciplinary research network comprising scientists and physicians from hospitals and practices dedicated to improving the management of atrial fibrillation through coordinated research in Germany and Europe. Its main objective is to conduct high quality investigator-initiated clinical trials and registries on a national and international level. The AFNET continues the long-term activities of the network which has been funded by the German Federal Ministry of Research and Education over a decade. Since January 2015, specific projects and infrastructures of the AFNET are funded by the German Centre for Cardiovascular Research (DZHK). http://www.af-net.eu
The European Heart Rhythm Association (EHRA) is a registered branch of the European Society of Cardiology (ESC). Its aim is to improve the quality of life of the European population by reducing the impact of cardiac arrhythmias and reducing sudden cardiac death. EHRA promotes science and education in the field of cardiac arrhythmias with a special focus on AF. Besides patient engagement programs EHRA organizes scientific and educational events for physicians and allied professionals. In cooperation with other associations and societies EHRA promotes the quality of care for patients with atrial fibrillation with the publication of international consensus documents. http://www.escardio.org/EHRA
The European Society of Cardiology (ESC) represents more than 90 000 cardiology professionals across Europe and worldwide. Its mission is to reduce the burden of cardiovascular disease in Europe. http://www.escardio.org