Research Priorities in the Secondary Prevention of Atrial Fibrillation: A National Heart, Lung, and Blood Institute Virtual Workshop Report

Abstract

There has been sustained focus on the secondary prevention of coronary heart disease and heart failure; yet, apart from stroke prevention, the evidence base for the secondary prevention of atrial fibrillation (AF) recurrence, AF progression, and AF‐related complications is modest. Although there are multiple observational studies, there are few large, robust, randomized trials providing definitive effective approaches for the secondary prevention of AF. Given the increasing incidence and prevalence of AF nationally and internationally, the AF field needs transformative research and a commitment to evidenced‐based secondary prevention strategies. We report on a National Heart, Lung, and Blood Institute virtual workshop directed at identifying knowledge gaps and research opportunities in the secondary prevention of AF. Once AF has been detected, lifestyle changes and novel models of care delivery may contribute to the prevention of AF recurrence, AF progression, and AF‐related complications. Although benefits seen in small subgroups, cohort studies, and selected randomized trials are impressive, the widespread effectiveness of AF secondary prevention strategies remains unknown, calling for development of scalable interventions suitable for diverse populations and for identification of subpopulations who may particularly benefit from intensive management. We identified critical research questions for 6 topics relevant to the secondary prevention of AF: (1) weight loss; (2) alcohol intake, smoking cessation, and diet; (3) cardiac rehabilitation; (4) approaches to sleep disorders; (5) integrated, team‐based care; and (6) nonanticoagulant pharmacotherapy. Our goal is to stimulate innovative research that will accelerate the generation of the evidence to effectively pursue the secondary prevention of AF.

Alcohol Consumption and Risk of Atrial Fibrillation: A Dose-Response Meta-Analysis of Prospective Studies

“…Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, which results in a 4- to 5- fold increased risk for stroke, tripling of the risk for heart failure, and 40–90% higher risk for all-cause mortality ( 1 ). Previous studies have revealed multiple risk factors for AF, including older age, male sex, concomitant cardiovascular conditions, diabetes, and sleep apnea ( 2 , 3 ).…”

Smartwatch monitoring for atrial fibrillation after stroke—The Pulsewatch Study: Protocol for a multiphase randomized controlled trial

“…Acceptable and accurate technologies for pAF monitoring are needed. 43 Forty-five percent of stroke treatment costs are incurred from acute care and monitoring. 7 Pulsewatch offers a lower-cost monitor that would accelerate the diagnosis and treatment of pAF in elderly stroke patients, preventing further strokes and thus decreasing the overall cost of treating stroke.…”

A Retrospective Study to Determine the Association Between Serum Albumin Levels and Atrial Fibrillation by Sex in 950 Patients from a Single Center in China

“…Furthermore, the success rate of a single operation is only 66.6% in paroxysmal AF [ 11 ]. Meanwhile, despite multifaceted efforts, prevention of AF remains challenging [ 12 ] and it is essential to investigate the correlation and mechanisms between potential modifiable risk factors and AF.…”