A roadmap to improve the quality of atrial fibrillation management: proceedings from the fifth Atrial Fibrillation Network/European Heart Rhythm Association consensus conference

Paulus Kirchhof; Günter Breithardt; Jeroen Bax; Gerlinde Benninger; Carina Blomstrom-Lundqvist; Giuseppe Boriani; Axel Brandes; Helen Brown; Martina Brueckmann; Hugh Calkins; Melanie Calvert; Vincent Christoffels; Harry Crijns; Dobromir Dobrev; Patrick Ellinor; Larissa Fabritz; Thomas Fetsch; S Ben Freedman; Andrea Gerth; Andreas Goette; Eduard Guasch; Guido Hack; Laurent Haegeli; Stephane Hatem; Karl Georg Haeusler; Hein Heidbüchel; Jutta Heinrich-Nols; Francoise Hidden-Lucet; Gerd Hindricks; Steen Juul-Möller; Stefan Kääb; Lukas Kappenberger; Stefanie Kespohl; Dipak Kotecha; Deirdre A Lane; Angelika Leute; Thorsten Lewalter; Ralf Meyer; Lluis Mont; Felix Münzel; Michael Nabauer; Jens C Nielsen; Michael Oeff; Jonas Oldgren; Ali Oto; Jonathan P Piccini; Art Pilmeyer; Tatjana Potpara; Ursula Ravens; Holger Reinecke; Thomas Rostock; Joerg Rustige; Irene Savelieva; Renate Schnabel; Ulrich Schotten; Lars Schwichtenberg; Moritz F Sinner; Gerhard Steinbeck; Monika Stoll; Luigi Tavazzi; Sakis Themistoclakis; Hung Fat Tse; Isabelle C Van Gelder; Panagiotis E Vardas; Timo Varpula; Alphons Vincent; David Werring; Stephan Willems; André Ziegler; Gregory Y H Lip; A John Camm

doi:10.1093/europace/euv304

A roadmap to improve the quality of atrial fibrillation management: proceedings from the fifth Atrial Fibrillation Network/European Heart Rhythm Association consensus conference

Europace. 2016 Jan;18(1):37-50. doi: 10.1093/europace/euv304. Epub 2015 Oct 18.

Authors

Paulus Kirchhof¹, Günter Breithardt², Jeroen Bax³, Gerlinde Benninger⁴, Carina Blomstrom-Lundqvist⁵, Giuseppe Boriani⁶, Axel Brandes⁷, Helen Brown⁸, Martina Brueckmann⁹, Hugh Calkins¹⁰, Melanie Calvert¹¹, Vincent Christoffels¹², Harry Crijns¹³, Dobromir Dobrev¹⁴, Patrick Ellinor¹⁵, Larissa Fabritz¹⁶, Thomas Fetsch¹⁷, S Ben Freedman¹⁸, Andrea Gerth¹⁹, Andreas Goette²⁰, Eduard Guasch²¹, Guido Hack²², Laurent Haegeli²³, Stephane Hatem²⁴, Karl Georg Haeusler²⁵, Hein Heidbüchel²⁶, Jutta Heinrich-Nols²⁷, Francoise Hidden-Lucet²⁸, Gerd Hindricks²⁹, Steen Juul-Möller³⁰, Stefan Kääb³¹, Lukas Kappenberger³², Stefanie Kespohl³³, Dipak Kotecha¹¹, Deirdre A Lane¹¹, Angelika Leute⁴, Thorsten Lewalter³⁴, Ralf Meyer³⁵, Lluis Mont²¹, Felix Münzel³⁶, Michael Nabauer¹⁹, Jens C Nielsen³⁷, Michael Oeff³⁸, Jonas Oldgren³⁹, Ali Oto⁴⁰, Jonathan P Piccini⁴¹, Art Pilmeyer⁴², Tatjana Potpara⁴³, Ursula Ravens⁴⁴, Holger Reinecke⁴⁵, Thomas Rostock⁴⁶, Joerg Rustige³⁰, Irene Savelieva⁴⁷, Renate Schnabel⁴⁸, Ulrich Schotten⁴⁹, Lars Schwichtenberg³³, Moritz F Sinner⁵⁰, Gerhard Steinbeck⁵¹, Monika Stoll⁵², Luigi Tavazzi⁵³, Sakis Themistoclakis⁵⁴, Hung Fat Tse⁵⁵, Isabelle C Van Gelder⁵⁶, Panagiotis E Vardas⁵⁷, Timo Varpula⁵⁸, Alphons Vincent³⁵, David Werring⁵⁹, Stephan Willems⁴⁸, André Ziegler⁶⁰, Gregory Y H Lip¹¹, A John Camm⁴⁷

Affiliations

¹ University of Birmingham, Birmingham, UK Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany Atrial Fibrillation Network (AFNET), Germany p.kirchhof@bham.ac.uk.
² Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany Atrial Fibrillation Network (AFNET), Germany.
³ Leiden University Medical Center, Leiden, The Netherlands.
⁴ Atrial Fibrillation Network (AFNET), Germany.
⁵ Department of Cardiology, Institution of Medical Sciences, Uppsala University, Uppsala, Sweden.
⁶ DIMES Department, University of Bologna, Bologna, Italy.
⁷ Odense University Hospital, Odense, Denmark.
⁸ Meda Pharma SAS, Paris, France.
⁹ Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany.
¹⁰ The Johns Hopkins Hospital, Baltimore, MD, USA.
¹¹ University of Birmingham, Birmingham, UK.
¹² University of Amsterdam, Amsterdam, The Netherlands.
¹³ University Hospital Maastricht, Maastricht, The Netherlands.
¹⁴ University Duisburg-Essen, Essen, Germany.
¹⁵ Harvard University, Boston, USA.
¹⁶ University of Birmingham, Birmingham, UK Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany.
¹⁷ CRI-The Clinical Research Institute, Munich, Germany.
¹⁸ University of Sydney, Sydney, Australia.
¹⁹ Atrial Fibrillation Network (AFNET), Germany Ludwig-Maximilians-University, Munich, Germany.
²⁰ Atrial Fibrillation Network (AFNET), Germany St Vincenz Krankenhaus, Paderborn, Germany.
²¹ Hospital Clinic, Universitat de Barcelona, Barcelona, Catalonia, Spain.
²² Bristol-Myers Squibb GmbH & Co. KGaA, Munich, Germany.
²³ University Hospital, Zurich, Switzerland.
²⁴ Institute of Cardiometabolism and Nutrition, INSERM UMR S 1166, Paris, France.
²⁵ Atrial Fibrillation Network (AFNET), Germany Charité-Universitätsmedizin Berlin, Berlin, Germany.
²⁶ Hasselt University and Heart Center, Hasselt, Belgium.
²⁷ Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany.
²⁸ Hopital Pitié-Salpêtrière AP HP, Paris, France.
²⁹ University Hospital Leipzig, Leipzig, Germany.
³⁰ Cardiome Pharma Corp., Vancouver, Canada.
³¹ Ludwig-Maximilians-University, Munich, Germany DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany.
³² University of Lausanne, Lausanne, Switzerland.
³³ Bayer HealthCare AG, Berlin, Germany.
³⁴ Atrial Fibrillation Network (AFNET), Germany Isar Heart Center, Isarclinic Munich, Munich, Germany.
³⁵ Medtronic International Trading Sàrl, Tolochenaz, Switzerland.
³⁶ Daiichi Sankyo Europe GmbH, Munich, Germany.
³⁷ Aarhus University Hospital, Aarhus, Denmark.
³⁸ Atrial Fibrillation Network (AFNET), Germany Städtisches Klinikum Brandenburg, Brandenburg, Germany.
³⁹ Department of Cardiology, Institution of Medical Sciences, Uppsala University, Uppsala, Sweden Uppsala Clinical Research Center, Uppsala, Sweden.
⁴⁰ Department of Cardiology, Memorial Ankara Hospital, Ankara, Turkey.
⁴¹ Duke University Medical Center, Durham, NC, USA.
⁴² Boston Scientific, St Paul, MN, USA.
⁴³ School of Medicine, University of Belgrade, Clinical Centre of Serbia, Belgrade, Serbia.
⁴⁴ Atrial Fibrillation Network (AFNET), Germany TU Dresden, Dresden, Germany.
⁴⁵ Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany.
⁴⁶ Atrial Fibrillation Network (AFNET), Germany Universitätsmedizin Mainz, Mainz, Germany.
⁴⁷ St George's Hospital Medical School, London, UK.
⁴⁸ University Heart Center Hamburg, Germany.
⁴⁹ Atrial Fibrillation Network (AFNET), Germany University Hospital Maastricht, Maastricht, The Netherlands.
⁵⁰ Ludwig-Maximilians-University, Munich, Germany.
⁵¹ Atrial Fibrillation Network (AFNET), Germany Zentrum für Kardiologie am Klinikum Starnberg, Starnberg, Germany.
⁵² Genetic Epidemiology, Institute of Human Genetics, University of Muenster, Muenster, Germany CARIM Research School for Cardiovascular Diseases, University of Maastricht, Maastricht, The Netherlands.
⁵³ Ettore Sansavini Health Science Foundation, Cotignola, Italy.
⁵⁴ Ospedale dell'Angelo, Mestre-Venice, Italy.
⁵⁵ University of Hong Kong, Hong Kong, China.
⁵⁶ University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
⁵⁷ Heraklion University Hospital, Heraklion, Crete, Greece.
⁵⁸ VTT Technical Research Centre of Finland, Espoo, Finland.
⁵⁹ Stroke Research Group, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK.
⁶⁰ Roche Diagnostics International Ltd., Rotkreuz, Switzerland.

PMID: 26481149
DOI: 10.1093/europace/euv304

Abstract

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.

Keywords: Antiarrhythmic drugs; Anticoagulation; Atrial fibrillation; Bleeding; Cardiovascular risk; Catheter ablation; Outcomes; Quality of care; Rate control; Research; Research priorities.

Publication types

Consensus Development Conference, NIH
Research Support, Non-U.S. Gov't
Review

MeSH terms

Atrial Fibrillation / diagnosis*
Atrial Fibrillation / therapy*
Cardiology / standards*
Critical Pathways / standards*
Europe
Humans
Practice Guidelines as Topic*
Quality Improvement / standards*

Grants and funding

CDF-2015-08-074/DH_/Department of Health/United Kingdom