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Review
. 2021 May 27;16(1):41.
doi: 10.5334/gh.1023.

World Heart Federation Roadmap on Atrial Fibrillation - A 2020 Update

Ben Freedman #  1 , Gerhard Hindricks #  2 , Amitava Banerjee  3 , Adrian Baranchuk  4 , Chi Keong Ching  5 , Xin Du  6 , Donna Fitzsimons  7 , Jeff S Healey  8 , Takanori Ikeda  9 , Trudie C A Lobban  10 , Amam Mbakwem  11 , Calambur Narasimhan  12 , Lis Neubeck  13 , Peter Noseworthy  14 , Daniel M Philbin Jr  15 , Fausto J Pinto  16 , Joselyn Rwebembera  17 , Renate B Schnabel  18 , Jesper Hastrup Svendsen  19 , Luis Aguinaga  20 , Elena Arbelo  21 , Michael Böhm  22 , Hasan Ali Farhan  23 , F D Richard Hobbs  24 , Antoni Martínez-Rubio  25 , Claudio Militello  26 , Nitish Naik  27 , Jean Jacques Noubiap  28 , Pablo Perel  29 , Daniel José Piñeiro  30 , Antonio Luiz Ribeiro  31 , Janina Stepinska  32
Affiliations
Review

World Heart Federation Roadmap on Atrial Fibrillation - A 2020 Update

Ben Freedman et al. Glob Heart. .

Abstract

The World Heart Federation (WHF) commenced a Roadmap initiative in 2015 to reduce the global burden of cardiovascular disease and resultant burgeoning of healthcare costs. Roadmaps provide a blueprint for implementation of priority solutions for the principal cardiovascular diseases leading to death and disability. Atrial fibrillation (AF) is one of these conditions and is an increasing problem due to ageing of the world's population and an increase in cardiovascular risk factors that predispose to AF. The goal of the AF roadmap was to provide guidance on priority interventions that are feasible in multiple countries, and to identify roadblocks and potential strategies to overcome them. Since publication of the AF Roadmap in 2017, there have been many technological advances including devices and artificial intelligence for identification and prediction of unknown AF, better methods to achieve rhythm control, and widespread uptake of smartphones and apps that could facilitate new approaches to healthcare delivery and increasing community AF awareness. In addition, the World Health Organisation added the non-vitamin K antagonist oral anticoagulants (NOACs) to the Essential Medicines List, making it possible to increase advocacy for their widespread adoption as therapy to prevent stroke. These advances motivated the WHF to commission a 2020 AF Roadmap update. Three years after the original Roadmap publication, the identified barriers and solutions were judged still relevant, and progress has been slow. This 2020 Roadmap update reviews the significant changes since 2017 and identifies priority areas for achieving the goals of reducing death and disability related to AF, particularly targeted at low-middle income countries. These include advocacy to increase appreciation of the scope of the problem; plugging gaps in guideline management and prevention through physician education, increasing patient health literacy, and novel ways to increase access to integrated healthcare including mHealth and digital transformations; and greater emphasis on achieving practical solutions to national and regional entrenched barriers. Despite the advances reviewed in this update, the task will not be easy, but the health rewards of implementing solutions that are both innovative and practical will be great.

Keywords: AF; NOACs; WHF; atrial fibrillation; cardiology; digital technology.

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Conflict of interest statement

Ben Freedman reports prior fees and advisory board honoraria from Bayer Pharma AG, Boehringer Ingelheim, Daiichi-Sankyo, Omron and Pfizer/BMS, loan devices from Alivecor, and grants to the institution for investigator-initiated studies from BMS/Pfizer, unrelated to the current work. Jeff Healey has held research grants and received speaking fees from BMS/Pfizer, Bayer, Servier, Medtronic, Boston Scientific, Abbott, ARCA biopharma, Cipher pharma, and Myokardia. Lis Neubeck has received honoraria from Pfizer BMS and Daiichi Sankyo (<£2000). Renate Schnabel has received lecture fees from BMS/Pfizer outside this work. Jesper Hastrup Svendsen reports grants, personal fees, and other from Medtronic and grants from Gilead. Isabel Arbelo has received speaker fees from Biosense Webster. FD Richard Hobbs has received occasional fees and or travel expenses reimbursed in the past five years for consultancy, speaking, or advisory meetings from BI and Bayer. Janina Stepinska has received research grants from Bayer and Sanofi; consulting or lecture fees from AstraZeneca, Bayer, Boehringer Ingelheim, Novartis, Pfizer, Sanofi, and Servier. Antoni Martínez-Rubio has participated in scientific advisory boards or research projects financed by Bayer, Boehringer Ingelheim, Daichii-Sankyo, and Pfizer.

Figures

Figure 1
Figure 1
Ideal AF pathway © World Heart Federation.
Figure 2
Figure 2
Recording of ECG rhythm strip by a woman instructed by a village health worker using a mobile hand-held smartphone ECG device. Reprinted from International Journal of Cardiology, 280, Soni A, Karna S, Fahey N, Sanghai S, Patel H, Raithatha S, et al., Age-and-sex Stratified Prevalence of Atrial Fibrillation in Rural Western India: Results of SMARTIndia, a population-based screening study, pp. 84–88, 2019, with permission from Elsevier.
Figure 3
Figure 3
Proposed hub-and-spoke model of oral anticoagulant therapy in patients with atrial fibrillation in low- and middle-income countries. Specialist doctor at hub – If no specialist is available, the hub may be a GP. GP – general practitioner, HW – health worker at spoke. P – the depicted Patient (P) here has point-of-care INR monitoring facility and dosage adjustment and data sharing app.
Figure 4
Figure 4
Key educational points to convey to the patients with atrial fibrillation at each visit by physicians. © World Heart Federation. Adapted based on the 2018 European Heart Rhythm Association Practical Guide recommendations [264].
See this image and copyright information in PMC

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