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Screening to reduce the burden of atrial fibrillation and complications in Europe

Comment by Maja-Lisa Løchen, Population Science and Public Health Section

Preventive Cardiology
Atrial Fibrillation

Atrial fibrillation (AF) is common (about 2,5%), it increases by age, and due to the increasing proportion of the aging population, we are expecting an AF epidemic in the following decades. AF is asymptomatic in about 1/3 of the patients, it is an important risk factor for stroke, and stroke is the first symptom of AF in 10% of the stroke patients. ESC guidelines recommend screening for AF to prevent complications and comorbidities and improve treatment (1).

Many clinical and research questions on whom to screen and how to screen most effectively are unanswered. In the ongoing EU-funded AFFECT-EU research and innovation project and with ESC as a non-profit partner, the aim is to develop a risk-based screening strategy using digital applications for rhythm monitoring. In a short article published recently, the leading team presents the AFFECT-EU project (2). Although many AF screening studies have been performed, there is a lack of knowledge on the screening effect in the general population and in primary care. In addition, little is known about the risk associated with very short duration of AF rhythm (less than 30 seconds which is necessary for an AF diagnosis). Therefore, the use of oral anticoagulation or not in these patients is an unanswered question. By merging information from many screening trials, AFFECT-EU will study the benefits and risks of various screening methods based on simulation models.

Further, studies based on large European epidemiological population cohorts with information on a number of risk factors, will contribute to identify high-risk populations for early AF diagnosis. Health economic studies related to different AF screening strategies, and evaluation of the acceptance of AF screening implementation in patients and healthcare professionals in different European countries will be performed. Finally, focus is on increasing the awareness of the importance of detecting AF in the general population, stakeholders and healthcare professionals.

The EAPC President, Martin Halle, has emphasized improvement of risk factors as one of the key strategic focal points. In addition to being an arrhythmia, AF is a risk factor for premature mortality, stroke, heart failure, cognitive decline, and decreased quality of life. AF as well as AF-related complications are preventable. This EU Horizon 2020 funded project (2) is intended to reduce the burden of AF through focusing on various aspects of AF screening and with ESC as a non-profit partner.


Maja-Lisa Løchen commented on this article:

2. Engler D, Heidbuchel H, Schnabel RB. Digital, risk-based screening for atrial fibrillation in the European community-the AFFECT-EU project funded by the European Union. Eur Heart J. 2021 Jul 15;42(27):2625-2627. doi: 10.1093/eurheartj/ehab050.

other references:

1. Hindricks G, Potpara T, Dagres N, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J. 2021 Feb 1;42(5):373-498. doi: 10.1093/eurheartj/ehaa612.

Notes to editor

Note: The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.