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COVID-19 and Cardiology Read more

Can we improve early detection and diagnosis of Atrial Fibrillation?

New technology, medication adherence, empowering patients

Atrial Fibrillation (AF) is the most common arrhythmia and affects about 2% of the population in Europe. This prevalence is going to increase. One in four people who are 40 years old or over are likely to develop AF, and almost all of them are at high risk of developing stroke. Oral anticoagulants can prevent the majority of ischemic strokes in AF patients.

The ESC’s Cardiovascular Round Table brought together an expert group of academics, clinical practice guideline writers, patient, regulatory and industry representatives, all of whom are intricately involved in the development of NOACs in phase III trials, to discuss unanswered questions.

Paulus Kirchhof, FESC, explains why early detection and diagnosis of AF is a critical issue for all health stakeholders

Slides and webcasts

Access slides and webcasts from a selection of presentations made during the CRT workshop.

Title Speaker Presentation Webcast
Population Screening (STROKESTOP etc.) Marten Rosenqvist    
Technology-based prescreening (BP devices, Fitbit etc., smartphone apps) Rolf Wachter    
Patients with multiple co-morbidities (based on phase III trials) Christian Ruff    
Biological heart valves, MitraClip / TAVI Stephan Windecker    
Cardioversion / Ablation Andreas Goette    
Patient preference and patient empowerment Inga Drossart    
IT tools to track & foster therapy adherence Jeroen Hendriks    

Take home messages

A summary of the main points from the workshop co-chairs, Prof. Paulus Kirchhof, FESC and Dr. Stefan Schroeder.

Can we use eHealth (sensors/devices) to improve early detection/diagnosis of AF?
  • Screening for atrial fibrillation is an active area of research; several uncertainties need to be addressed:
    • how to best identify these patients
    • which patients should be screened
    • whether the risk of patients identified via screening is similar to that of patients with symptomatic atrial fibrillation
    • whether identification and treatment of these patients reduces the risk of systemic embolic events
  • Devices can only be used for pre-screening, not for diagnosis. One should differentiate between short-term devices (for example Zenicor, AliveCor® and smartphone Apps) and longer-term screening technologies (Wearable patches, Loop recorders and Holter monitoring)
  • Implanted devices have a greater sensitivity for atrial fibrillation detection since monitoring is continuous rather than intermittent but “Normal” and “abnormal” needs to be validated.
Anticoagulation in Specific Populations
  • As a class, non-VKA oral anticoagulants are broadly as effective as warfarin to reduce ischemic stroke, but they are associated with less major bleeding and hemorrhagic stroke than warfarin.
  • Patients with multiple comorbidities are usually at higher risk for bleeding, yet the available data suggest that the risk of major bleeding is lower with non-VKA oral anticoagulants than with warfarin
  • The efficacy and safety of non-VKA oral anticoagulants in patients with mild renal impairment appear to be similar to that observed in patients with normal renal function. Data in patients with severe kidney disease is lacking.
  • Available data suggest that the continuation of non-VKA oral anticoagulation is effective and safe in the setting of cardioversion or catheter ablation as well as in patients with valvular heart disease
  • Triple therapy for 1-6 months should be considered in patients in whom the bleeding risk is low in comparison to the risk for stent thrombosis and the duration should be shortened in patients whose bleeding risk is higher than that for stent thrombosis. Aspirin can probably be omitted in patients who are not at highest risk of stent thrombosis.
How to improve medication persistence/adherence to achieve maximal benefit for AF patients?
  • Patients need to be educated about the risk of stroke versus the risk of bleeding, so they can make informed decisions based on accurate information rather than fear. Informed, empowered patients can help to improve adherence to therapy.
  • The ESC is committed to developing evidence-based education offerings that respond to the needs of their members and supports the improvement of patient outcomes.
  • Outcomes after bleeding appear to be better with non-VKA oral anticoagulants than warfarin in terms of lower rates of life-threatening and fatal bleeding, even without specific reversal agents, and a higher likelihood of restarting anticoagulant therapy after resolution of the bleeding event.
  • The 2016 ESC guidelines for the management of atrial fibrillation recommended integrated atrial fibrillation management, which helps to render patients “owners” of their atrial fibrillation management. Integrated AF care also provides a mechanism to ensure that patients who need subspecialty care are identified and referred as clinically indicated. Technology tools, such as decision support software, facilitate the delivery of integrated chronic care by recommending the most appropriate guideline management based on the individual patient profile and stroke risk.

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