Dynamic risk assessment to improve quality of care in patients with atrial fibrillation: the 7th AFNET/EHRA Consensus Conference
Larissa Fabritz, Harry J.G.M. Crijns, Eduard Guasch, Andreas Goette, Karl Georg Häusler, Dipak Kotecha, Thorsten Lewalter, Christian Meyer, Tatjana Potpara, Michiel Rienstra, Renate B. Schnabel, Stephan Willems, G Breithardt, A. John Camm, Anthony K.C. Chan, Winnie Chua, Mirko De Melis, Christina Dimopoulou, Dobromir Dobrev, Christina Easter, Lars Eckardt, Doreen Haase, Stéphane Hatem, Jeff S. Healey, Jordi Heijman, Stefan H. Hohnloser, Thomas Huebner, Bushra Saeed Ilyas, Aaron Isaacs, Ingo Kutschka, Christophe Leclercq, Gregory Y.H. Lip, Elena Andreassi Marinelli, José Luís Merino, Lluı́s Mont, Michael Näbauer, Jonas Oldgren, Helmut Pürerfellner, Ursula Ravens, Irina Savelieva, Moritz F. Sinner, Alice Sitch, Rüdiger Smolnik, Jan Steffel, Kenneth M. Steín, Monika Stoll, Emma Svennberg, Dierk Thomas, Isabelle C. Van Gelder, Burcu Vardar, Reza Wakili, Mattias Wieloch, Stef Zeemering, Paul Ziegler, Hein Heidbüchel, Gerhard Hindricks, Ulrich Schotten, Paulus Kirchhof
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.