European Primary Care Cardiovascular Society

German AFNET and EHRA lay out roadmap to improve AF management

Oct. 19, 2015 - news

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 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.

   
  Structured care

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.”
 

Source:

Press release ESC October 19, 2015
Publication: 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