A roadmap to improve the quality of atrial fibrillation management: proceedings from the fifth Atrial Fibrillation Network/European Heart Rhythm Association consensus conference.
At least 30 million people worldwide carry a diagnosis of atrial fibrillation (AF), and many more suffer from undiagnosed, subclinical, or 'silent' AF. Atrial fibrillation-related cardiovascular mortality and morbidity, including cardiovascular deaths, heart failure, stroke, and hospitalizations, remain unacceptably high, even when evidence-based therapies such as anticoagulation and rate control are used. Furthermore, it is still necessary to define how best to prevent AF, largely due to a lack of clinical measures that would allow identification of treatable causes of AF in any given patient. Hence, there are important unmet clinical and research needs in the evaluation and management of AF patients. The ensuing needs and opportunities for improving the quality of AF care were discussed during the fifth Atrial Fibrillation Network/European Heart Rhythm Association consensus conference in Nice, France, on 22 and 23 January 2015. Here, we report the outcome of this conference, with a focus on (i) learning from our 'neighbours' to improve AF care, (ii) patient-centred approaches to AF management, (iii) structured care of AF patients, (iv) improving the quality of AF treatment, and (v) personalization of AF management. This report ends with a list of priorities for research in AF patients.
University of Birmingham, Birmingham, UK Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany Atrial Fibrillation Network (AFNET), Germany p.kirchhof@bham.ac.uk.
Paulus
P
Kirchhof
Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany Atrial Fibrillation Network (AFNET), Germany.
Günter
G
Breithardt
Leiden University Medical Center, Leiden, The Netherlands.
Jeroen
J
Bax
Atrial Fibrillation Network (AFNET), Germany.
Gerlinde
G
Benninger
Department of Cardiology, Institution of Medical Sciences, Uppsala University, Uppsala, Sweden.
Carina
C
Blomstrom-Lundqvist
DIMES Department, University of Bologna, Bologna, Italy.
Giuseppe
G
Boriani
Odense University Hospital, Odense, Denmark.
Axel
A
Brandes
Meda Pharma SAS, Paris, France.
Helen
H
Brown
Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany.
Martina
M
Brueckmann
The Johns Hopkins Hospital, Baltimore, MD, USA.
Hugh
H
Calkins
University of Birmingham, Birmingham, UK.
Melanie
M
Calvert
University of Amsterdam, Amsterdam, The Netherlands.
Vincent
V
Christoffels
University Hospital Maastricht, Maastricht, The Netherlands.
Harry
H
Crijns
University Duisburg-Essen, Essen, Germany.
Dobromir
D
Dobrev
Harvard University, Boston, USA.
Patrick
P
Ellinor
University of Birmingham, Birmingham, UK Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany.
Larissa
L
Fabritz
CRI-The Clinical Research Institute, Munich, Germany.
Thomas
T
Fetsch
University of Sydney, Sydney, Australia.
S Ben
SB
Freedman
Atrial Fibrillation Network (AFNET), Germany Ludwig-Maximilians-University, Munich, Germany.
Andrea
A
Gerth
Atrial Fibrillation Network (AFNET), Germany St Vincenz Krankenhaus, Paderborn, Germany.
Andreas
A
Goette
Hospital Clinic, Universitat de Barcelona, Barcelona, Catalonia, Spain.
Eduard
E
Guasch
Bristol-Myers Squibb GmbH & Co. KGaA, Munich, Germany.
Guido
G
Hack
University Hospital, Zurich, Switzerland.
Laurent
L
Haegeli
Institute of Cardiometabolism and Nutrition, INSERM UMR S 1166, Paris, France.
Stephane
S
Hatem
Atrial Fibrillation Network (AFNET), Germany Charité-Universitätsmedizin Berlin, Berlin, Germany.
Karl Georg
KG
Haeusler
Hasselt University and Heart Center, Hasselt, Belgium.
Hein
H
Heidbüchel
Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany.
Jutta
J
Heinrich-Nols
Hopital Pitié-Salpêtrière AP HP, Paris, France.
Francoise
F
Hidden-Lucet
University Hospital Leipzig, Leipzig, Germany.
Gerd
G
Hindricks
Cardiome Pharma Corp., Vancouver, Canada.
Steen
S
Juul-Möller
Ludwig-Maximilians-University, Munich, Germany DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany.
Stefan
S
Kääb
University of Lausanne, Lausanne, Switzerland.
Lukas
L
Kappenberger
Bayer HealthCare AG, Berlin, Germany.
Stefanie
S
Kespohl
University of Birmingham, Birmingham, UK.
Dipak
D
Kotecha
University of Birmingham, Birmingham, UK.
Deirdre A
DA
Lane
Atrial Fibrillation Network (AFNET), Germany.
Angelika
A
Leute
Atrial Fibrillation Network (AFNET), Germany Isar Heart Center, Isarclinic Munich, Munich, Germany.
Thorsten
T
Lewalter
Medtronic International Trading Sàrl, Tolochenaz, Switzerland.
Ralf
R
Meyer
Hospital Clinic, Universitat de Barcelona, Barcelona, Catalonia, Spain.
Lluis
L
Mont
Daiichi Sankyo Europe GmbH, Munich, Germany.
Felix
F
Münzel
Atrial Fibrillation Network (AFNET), Germany Ludwig-Maximilians-University, Munich, Germany.
Michael
M
Nabauer
Aarhus University Hospital, Aarhus, Denmark.
Jens C
JC
Nielsen
Atrial Fibrillation Network (AFNET), Germany Städtisches Klinikum Brandenburg, Brandenburg, Germany.
Michael
M
Oeff
Department of Cardiology, Institution of Medical Sciences, Uppsala University, Uppsala, Sweden Uppsala Clinical Research Center, Uppsala, Sweden.
Jonas
J
Oldgren
Department of Cardiology, Memorial Ankara Hospital, Ankara, Turkey.
Ali
A
Oto
Duke University Medical Center, Durham, NC, USA.
Jonathan P
JP
Piccini
Boston Scientific, St Paul, MN, USA.
Art
A
Pilmeyer
School of Medicine, University of Belgrade, Clinical Centre of Serbia, Belgrade, Serbia.
Tatjana
T
Potpara
Atrial Fibrillation Network (AFNET), Germany TU Dresden, Dresden, Germany.
Ursula
U
Ravens
Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany.
Holger
H
Reinecke
Atrial Fibrillation Network (AFNET), Germany Universitätsmedizin Mainz, Mainz, Germany.
Thomas
T
Rostock
Cardiome Pharma Corp., Vancouver, Canada.
Joerg
J
Rustige
St George's Hospital Medical School, London, UK.
Irene
I
Savelieva
University Heart Center Hamburg, Germany.
Renate
R
Schnabel
Atrial Fibrillation Network (AFNET), Germany University Hospital Maastricht, Maastricht, The Netherlands.
Ulrich
U
Schotten
Bayer HealthCare AG, Berlin, Germany.
Lars
L
Schwichtenberg
Ludwig-Maximilians-University, Munich, Germany.
Moritz F
MF
Sinner
Atrial Fibrillation Network (AFNET), Germany Zentrum für Kardiologie am Klinikum Starnberg, Starnberg, Germany.
Gerhard
G
Steinbeck
Genetic Epidemiology, Institute of Human Genetics, University of Muenster, Muenster, Germany CARIM Research School for Cardiovascular Diseases, University of Maastricht, Maastricht, The Netherlands.
Monika
M
Stoll
Ettore Sansavini Health Science Foundation, Cotignola, Italy.
Luigi
L
Tavazzi
Ospedale dell'Angelo, Mestre-Venice, Italy.
Sakis
S
Themistoclakis
University of Hong Kong, Hong Kong, China.
Hung Fat
HF
Tse
University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Isabelle C
IC
Van Gelder
Heraklion University Hospital, Heraklion, Crete, Greece.
Panagiotis E
PE
Vardas
VTT Technical Research Centre of Finland, Espoo, Finland.
Timo
T
Varpula
Medtronic International Trading Sàrl, Tolochenaz, Switzerland.
Alphons
A
Vincent
Stroke Research Group, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK.
David
D
Werring
University Heart Center Hamburg, Germany.
Stephan
S
Willems
Roche Diagnostics International Ltd., Rotkreuz, Switzerland.
André
A
Ziegler
University of Birmingham, Birmingham, UK.
Gregory Y H
GY
Lip
St George's Hospital Medical School, London, UK.
A John
AJ
Camm
D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000628:therapy*; D002309:Cardiology / Q000592:standards*; D019091:Critical Pathways / Q000592:standards*; D005060:Europe; D006801:Humans; D058996:Quality Improvement / Q000592:standards*
Antiarrhythmic drugs; Anticoagulation; Atrial fibrillation; Bleeding; Cardiovascular risk; Catheter ablation; Outcomes; Quality of care; Rate control; Research; Research priorities