Dynamic risk assessment to improve quality of care in patients with atrial fibrillation: the 7th AFNET/EHRA Consensus Conference

Larissa Fabritz^{1

2}, Harry J G M Crijns³, Eduard Guasch⁴, Andreas Goette^{5

6}, Karl Georg Häusler⁷, Dipak Kotecha¹, Thorsten Lewalter^{6

8}, Christian Meyer⁹, Tatjana S Potpara¹⁰, Michiel Rienstra¹¹, Renate B Schnabel^{6

9}, Stephan Willems^{6

12}, Guenter Breithardt^{6

12

13}, A John Camm¹⁴, Anthony Chan¹⁵, Winnie Chua¹, Mirko de Melis¹⁶, Christina Dimopoulou¹⁷, Dobromir Dobrev¹⁸, Christina Easter¹, Lars Eckardt^{6

13}, Doreen Haase⁶, Stephane Hatem¹⁹, Jeff S Healey²⁰, Jordi Heijman², Stefan H Hohnloser²¹, Thomas Huebner²², Bushra Saeed Ilyas¹⁵, Aaron Isaacs³, Ingo Kutschka^{6

23}, Christophe Leclercq²⁴, Gregory Y H Lip²⁵, Elena Andreassi Marinelli²⁶, Jose L Merino²⁷, Lluís Mont²⁸, Michael Nabauer^{6

29}, Jonas Oldgren³⁰, Helmut Pürerfellner³¹, Ursula Ravens^{6

32}, Irina Savelieva³³, Moritz F Sinner²⁹, Alice Sitch¹, Rüdiger Smolnik²⁶, Jan Steffel³⁴, Kenneth Stein³⁵, Monika Stoll³, Emma Svennberg³⁶, Dierk Thomas^{6

37}, Isabelle C Van Gelder³⁸, Burcu Vardar³⁹, Reza Wakili^{6

18}, Mattias Wieloch⁴⁰, Stef Zeemering³⁸, Paul D Ziegler¹⁶, Hein Heidbuchel⁴¹, Gerhard Hindricks⁴², Ulrich Schotten^{3

6

38}, Paulus Kirchhof^{1

6

9}

Affiliations

¹ Institute of Cardiovascular Sciences, University of Birmingham, UK.
² Department of Cardiology, University Hospital Birmingham, UK.
³ School for Cardiovascular Diseases, Maastricht University Medical Centre, the Netherlands.
⁴ Hospital Clinic, IDIBAPS, CIBERCV, University of Barcelona, Spain.
⁵ Medical Clinic II, St. Vincenz Krankenhaus, Paderborn, Germany.
⁶ Atrial Fibrillation NETwork (AFNET), Münster, Germany.
⁷ Department of Neurology, University Hospital Würzburg, Germany.
⁸ Internistisches Klinikum München Süd, Germany.
⁹ University Heart Center, University Hospital Hamburg-Eppendorf, Germany.
¹⁰ School of Medicine, University of Belgrade, Clinical Centre of Serbia, Serbia.
¹¹ University Medical Center Groningen, the Netherlands.
¹² Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
¹³ Department of Cardiovascular Medicine, University Hospital Münster, Germany.
¹⁴ St George's Hospital Medical School, University of London, UK.
¹⁵ Pfizer.
¹⁶ Medtronic.
¹⁷ European Society of Cardiology.
¹⁸ Department of Cardiology, University Hospital Essen, Germany.
¹⁹ Department of Cardiology, Sorbonne Universités, Faculté de médecine UPMC, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris, France.
²⁰ Population Health Research Institute Hamilton, Canada.
²¹ Department of Cardiology, Goethe-University of Frankfurt, Germany.
²² Preventicus, Germany.
²³ Klinik für Thorax-, Herz- und Gefäßchirurgie, University Hospital Göttingen, Germany.
²⁴ Univ Rennes, CHU Rennes, INSERM, LTSI-UMR 1099, F-35000 Rennes, France.
²⁵ Liverpool Centre for Cardiovascular Science, University of Liverpool, UK.
²⁶ Daiichi Sankyo Europe.
²⁷ Arrhythmia & Robotic EP Unit, La Paz University Hospital, Spain.
²⁸ Hospital Clinic, Universitat de Barcelona, Barcelona, Catalonia, Spain.
²⁹ Medizinische Klinik und Poliklinik I, University Hospital Munich, Germany.
³⁰ Department of Medical Sciences, Uppsala Clinical Research Center, Uppsala University, Sweden.
³¹ Department für Rhythmologie und Elektrophysiologie, Ordensklinikum Linz, Austria.
³² Institut für Experimentelle Kardiovaskuläre Medizin, Universitätsherzzentrum Freiburg, Bad Krozingen, Germany.
³³ St. George's University of London, UK.
³⁴ University Heart Center Zurich, Switzerland.
³⁵ Boston Scientific, USA.
³⁶ Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd's Hospital Stockholm, Sweden.
³⁷ Department of Internal Medicine III-Cardiology, Angiology and Pneumonology, Medical University Hospital Heidelberg, Germany.
³⁸ Department of Cardiology, University Medical Center Groningen, University of Groningen, the Netherlands.
³⁹ Bayer Healthcare, Belgium.
⁴⁰ Sanofi, Paris, France.
⁴¹ Department of Cardiology, Antwerp University, University Hospital, Belgium.
⁴² Department of Electrophysiology, Heart Center Leipzig, University of Leipzig, Germany.

PMID: 33555020
DOI: 10.1093/europace/euaa279

Dynamic risk assessment to improve quality of care in patients with atrial fibrillation: the 7th AFNET/EHRA Consensus Conference

Larissa Fabritz et al. Europace. 2021.

. 2021 Mar 8;23(3):329-344.

doi: 10.1093/europace/euaa279.

Authors

Affiliations

¹ Institute of Cardiovascular Sciences, University of Birmingham, UK.
² Department of Cardiology, University Hospital Birmingham, UK.
³ School for Cardiovascular Diseases, Maastricht University Medical Centre, the Netherlands.
⁴ Hospital Clinic, IDIBAPS, CIBERCV, University of Barcelona, Spain.
⁵ Medical Clinic II, St. Vincenz Krankenhaus, Paderborn, Germany.
⁶ Atrial Fibrillation NETwork (AFNET), Münster, Germany.
⁷ Department of Neurology, University Hospital Würzburg, Germany.
⁸ Internistisches Klinikum München Süd, Germany.
⁹ University Heart Center, University Hospital Hamburg-Eppendorf, Germany.
¹⁰ School of Medicine, University of Belgrade, Clinical Centre of Serbia, Serbia.
¹¹ University Medical Center Groningen, the Netherlands.
¹² Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
¹³ Department of Cardiovascular Medicine, University Hospital Münster, Germany.
¹⁴ St George's Hospital Medical School, University of London, UK.
¹⁵ Pfizer.
¹⁶ Medtronic.
¹⁷ European Society of Cardiology.
¹⁸ Department of Cardiology, University Hospital Essen, Germany.
¹⁹ Department of Cardiology, Sorbonne Universités, Faculté de médecine UPMC, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris, France.
²⁰ Population Health Research Institute Hamilton, Canada.
²¹ Department of Cardiology, Goethe-University of Frankfurt, Germany.
²² Preventicus, Germany.
²³ Klinik für Thorax-, Herz- und Gefäßchirurgie, University Hospital Göttingen, Germany.
²⁴ Univ Rennes, CHU Rennes, INSERM, LTSI-UMR 1099, F-35000 Rennes, France.
²⁵ Liverpool Centre for Cardiovascular Science, University of Liverpool, UK.
²⁶ Daiichi Sankyo Europe.
²⁷ Arrhythmia & Robotic EP Unit, La Paz University Hospital, Spain.
²⁸ Hospital Clinic, Universitat de Barcelona, Barcelona, Catalonia, Spain.
²⁹ Medizinische Klinik und Poliklinik I, University Hospital Munich, Germany.
³⁰ Department of Medical Sciences, Uppsala Clinical Research Center, Uppsala University, Sweden.
³¹ Department für Rhythmologie und Elektrophysiologie, Ordensklinikum Linz, Austria.
³² Institut für Experimentelle Kardiovaskuläre Medizin, Universitätsherzzentrum Freiburg, Bad Krozingen, Germany.
³³ St. George's University of London, UK.
³⁴ University Heart Center Zurich, Switzerland.
³⁵ Boston Scientific, USA.
³⁶ Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd's Hospital Stockholm, Sweden.
³⁷ Department of Internal Medicine III-Cardiology, Angiology and Pneumonology, Medical University Hospital Heidelberg, Germany.
³⁸ Department of Cardiology, University Medical Center Groningen, University of Groningen, the Netherlands.
³⁹ Bayer Healthcare, Belgium.
⁴⁰ Sanofi, Paris, France.
⁴¹ Department of Cardiology, Antwerp University, University Hospital, Belgium.
⁴² Department of Electrophysiology, Heart Center Leipzig, University of Leipzig, Germany.

PMID: 33555020
DOI: 10.1093/europace/euaa279

Abstract

Aims: The risk of developing atrial fibrillation (AF) and its complications continues to increase, despite good progress in preventing AF-related strokes.

Methods and results: This article summarizes the outcomes of the 7th Consensus Conference of the Atrial Fibrillation NETwork (AFNET) and the European Heart Rhythm Association (EHRA) held in Lisbon in March 2019. Sixty-five international AF specialists met to present new data and find consensus on pressing issues in AF prevention, management and future research to improve care for patients with AF and prevent AF-related complications. This article is the main outcome of an interactive, iterative discussion between breakout specialist groups and the meeting plenary. AF patients have dynamic risk profiles requiring repeated assessment and risk-based therapy stratification to optimize quality of care. Interrogation of deeply phenotyped datasets with outcomes will lead to a better understanding of the cardiac and systemic effects of AF, interacting with comorbidities and predisposing factors, enabling stratified therapy. New proposals include an algorithm for the acute management of patients with AF and heart failure, a call for a refined, data-driven assessment of stroke risk, suggestions for anticoagulation use in special populations, and a call for rhythm control therapy selection based on risk of AF recurrence.

Conclusion: The remaining morbidity and mortality in patients with AF needs better characterization. Likely drivers of the remaining AF-related problems are AF burden, potentially treatable by rhythm control therapy, and concomitant conditions, potentially treatable by treating these conditions. Identifying the drivers of AF-related complications holds promise for stratified therapy.

Keywords: AFNET; Anticoagulation; Outcomes; Atrial cardiomyopathy; Atrial fibrillation; Big data; Bleeding; Catheter ablation; Cognitive function; Consensus statement; EHRA; Heart failure; Integrated care; Lifestyle; Quality of care; Rate control; Research; Research priorities; Rhythm control; Screening; Stroke; Technology.

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Dynamic risk assessment to improve quality of care in patients with atrial fibrillation: the 7th AFNET/EHRA Consensus Conference

Affiliations

Dynamic risk assessment to improve quality of care in patients with atrial fibrillation: the 7th AFNET/EHRA Consensus Conference

Authors

Affiliations

Abstract

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Substances

LinkOut - more resources

Full Text Sources

Medical

Miscellaneous