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

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 proplems 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.

Atrial Cardiomyopathy: Pathophysiology and Clinical Consequences

“…Diseases or conditions such as diabetes mellitus, heart failure, and ageing (CHA2DS2VASc Parameters) are known to increase alterations by oxidative stress pathways within endothelial cells, and thereby further increase the expression of prothrombogenic molecules. These changes are not related to the presence of absence of AF, explaining why atrial thrombogenesis is still increased even during sinus rhythm in certain subgroups of patients [211,212]. Recently, post hoc studies from large randomized controlled trials suggested that the burden of AF (Figure 3) as well as the type of AF (paroxysmal versus persistent/permanent AF) might be a factor, which drives differences in patient outcome [213][214][215][216][217].…”

Heart failure in patients with atrial fibrillation: why it matters now more than ever

“…For heart failure with preserved ejection fraction, this identification can be achieved by observing if patients respond well to diuretics (heart failure dominant) or rate control and cardioversion (AF dominant). Treatment of underlying factors would likely benefit heart failure dominant patients while AF dominant patients would benefit from antiarrhythmic therapies 4 . This approach is one of the promising avenues to personalise therapies in patients with concomitant AF and heart failure for better outcomes.…”

Update Vorhofflimmern: Die ESC-Leitlinien 2020 sowie aktuelle Daten zur frühen antiarrhythmischen Therapie

“…Schätzungen zufolge wird zeitlebens jeder dritte heute 55-Jährige an Vorhofflimmern erkranken [1]. Vorhofflimmern ist mit gefährlichen kardiovaskulären Komplikationen assoziiert, insbesondere Herzinsuffizienz, Schlaganfall und kardiovaskulärem Tod [2]. Meilensteine der Behandlung von Vorhofflimmern, welche zur maßgeblichen Reduktion der Mortalität als auch Morbidität geführt haben, sind die ora- Abb.…”