Personalised management is the only way to close the mortality gap for patients with atrial fibrillation (AF), according to an ESC consensus paper presented at ESC Congress 2013 by Professor Paulus Kirchhof (UK).
The Atrial Fibrillation competence NETwork (AFNET) and European Heart Rhythm Association (EHRA) consensus paper is published online in the European Journal of Pacing, Arrhythmias, and Cardiac Electrophysiology (EP-Europace)1 and presented during the ESC Congress session on personalised cardiology.
Professor Kirchhof said: "Acute and 1-year mortality after myocardial infarction has dropped by two-thirds in the last 10 to 15 years primarily because of medical interventions aimed at the principal pathophysiology causing the disease. For example acute revascularization procedures are used to treat a thrombotic blockage of the artery while statins prevent the development and rupture of coronary plaques."
But he added: "We are in an intermediate position with AF. With the introduction of oral anticoagulant therapy we can prevent about two-thirds of all strokes in AF. But patients with AF still have a higher mortality compared to their age and cardiovascular risk matched peers without AF, and we are not able to reduce that mortality by much even when we apply all the evidence based therapies."2,3
The fourth AFNET/EHRA consensus conference was convened to discuss how to identify the underlying main pathophysiologies of AF in individual patients so that more targeted therapies could be developed to close the mortality gap. Professor Kirchhof said: "This requires understanding the disease mechanisms and translating them into parameters we can measure in patients. This is particularly difficult for AF because the left atrium is a small part of the heart located posteriorly in the body and difficult to access."
A certain degree of personalisation is already practised in AF. Stroke risk scores based on clinically measurable risk factors aid decisions on anticoagulant therapy while the severity of AF symptoms help to determine rhythm control therapy.
The consensus paper identifies three main ways to better characterise the underlying cause of AF in order to improve treatment: the electrocardiogram (ECG); imaging, especially echocardiography and magnetic resonance imaging (MRI); and biomarkers (proteins or genes measured in blood to identify the type of AF).