Putting the patient first

At least 30 million people worldwide live with atrial fibrillation (AF). Despite significantly improved treatments, many AF patients still suffer strokes, heart failure, and premature deaths.

The German Atrial Fibrillation Network association (AFNET) and the European Heart Rhythm Association (EHRA) have initiated the development of a roadmap to improve the quality of AF management.  An international group of experts has recently developed a set of initiatives and recommendations aimed at improving the care for AF patients. The report of the 5th AFNET/EHRA consensus conference was published online in the EP Europace journal recently.

The recent 5th AFNET/EHRA consensus conference was focused on ‘Understanding and eliminating inequalities and barriers that prevent optimal treatment of atrial fibrillation’. 

Prof Paulus Kirchhof, one of the conference organisers, said: “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.

“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,” said Prof Gerhard Hindricks, president of the EHRA.

The experts agreed that for successful AF therapy, all patients should be involved in decisions about their care. 

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 five European languages now and released by the EHRA were considered very helpful in promoting patient engagement in the field of AF. Furthermore, patient-reported outcomes should be used to capture AF-related symptoms and patients’ experiences, it was stressed.

Adequate management of AF patients is complex. Prof Andreas Goette, board member of AFNET, said: “Such AF care should ensure that evidence-based therapy is offered to all AF patients.” 

The new roadmap recommends a more structured approach led by interdisciplinary teams and suggests the development of patient-centred care plans for all AF patients.

The 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, the experts said.

The authors recommended development of standards to consistently measure the quality and success of AF ablation. They point out that 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 treatment.

They say further research is required to better understand the underlying cellular and molecular mechanisms of AF, including 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. 

Prof A John Camm, president-elect of the EHRA and co-organiser of the AFNET/EHRA consensus conference, said: “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.”

The report of the 5th AFNET/EHRA consensus conference is published online in the EP Europace journal –
europace.oxfordjournals.org/

Meanwhile, the Irish Heart Foundation is currently promoting a public awareness campaign on AF. The Foundation has developed a range of AF information material for the public, including booklets, leaflets and posters , with the message ‘Find atrial fibrillation before a stroke finds you’. The booklet is designed for people living with AF, and includes information on symptoms, management of lifestyle changes in addition to an explanation of medical terms.

The IHF awareness campaign is run in association with Pfizer and Bristol-Myers Squibb.