Opportunities to better detect, manage and treat patients with undiagnosed atrial fibrillation

January 25, 2021

(Boston)--Atrial fibrillation (AF) is associated with a higher risk of complications including ischemic stroke, cognitive decline, heart failure, myocardial infarction and death. AF frequently is undetected until complications such as stroke or heart failure occur.

While the public and clinicians have an intense interest in detecting AF earlier, the most appropriate strategies to detect undiagnosed AF and medical prognosis and therapeutic implications of AF detected by screening are uncertain.

A new report led by Boston University School of Medicine (BUSM) researcher Emelia J. Benjamin, MD, ScM, builds upon a recently conducted National Heart, Lung, and Blood Institute's virtual workshop that focused on identifying key research priorities related to AF screening.

Global experts reviewed major knowledge gaps and identified critical research priorities in the following areas: 1) role of opportunistic screening; 2) AF as a risk factor, risk marker, or both; 3) relationship between AF burden detected with long-term monitoring and outcomes/treatments; 4) designs of potential randomized trials of systematic AF screening with clinically relevant outcomes; and 5) role of AF screening after ischemic stroke.

"The research gaps and opportunities outlined in the workshop will hopefully accelerate AF screening research to improve the diagnosis, management and prognosis of patients with undiagnosed AF," said corresponding author Benjamin, professor of medicine at BUSM.

According to the researchers several themes emerged from the workshop to advance the field of AF screening including developing a compelling evidence base and sharing data across studies and the need to investigate diverse patient subgroups (age, sex, race/ethnicity, urban/rural and comorbidities).

The researchers submit that close attention will need to be paid to both the potential benefits and adverse outcomes of AF screening strategies on the patient (anxiety, testing, treatment complications) and the health system (e.g., disparities, costs, and clinician liability and fatigue) before recommending widespread screening.

These findings appear in the journal Circulation.
-end-
Funding

Dr. Benjamin receives research funding from US NIH, National Heart, Lung, and Blood Institute grants R01HL128914, 2R01HL092577, R01HL141434 01A1, NIH National Institute of Aging grant R01AG066010 and American Heart Association: 18SFRN34110082.

Dr. Go receives research funding from US NIH, National Heart, Lung, and Blood Institute grant R01HL142834 and National Institute of Diabetes and Digestive and Kidney Diseases R01DK103612.

Dr. Anderson receives research funding NIH National Institute of Neurological Disorders and Stroke R01NS103924, the American Heart Association 18SFRN34250007

Dr. Casadei is supported by Programme Grants from the British Heart Foundation and by the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre..

Dr. Chen receives research funding from US NIH, National Heart, Lung, and Blood Institute R01HL126637, R01HL141288, and additional support from R01HL142599 and R01HL127659.

Dr. Crijns research research support from the Netherlands Cardiovascular Research Initiative: an initiative with support of the Dutch Heart Foundation, CVON 2014-9: Reappraisal of Atrial Fibrillation: Interaction Between HyperCoagulability, Electrical Remodeling, and Vascular Destabilisation in the Progression of AF (RACE V).

Dr. Van Gelder receives support from the Netherlands Cardiovascular Research Initiative: an initiative with support of the Dutch Heart Foundation, CVON 2014-9: Reappraisal of Atrial Fibrillation: Interaction Between HyperCoagulability, Electrical Remodeling, and Vascular Destabilisation in the Progression of AF (RACE V).

Dr. Kamel receives research funding NIH National Heart, Lung, and Blood Institute R01HL144541 and National Institute of Neurological Disorders and Stroke: R01NS097443.

Dr. Lubitz receives research funding from National Heart, Lung, and Blood Institute grant R01HL139731 and the American Heart Association 18SFRN34250007.

Dr. McManus receives support from US NIH, National Heart, Lung, and Blood Institute grant R01HL126911, R01HL137734, R01HL137794, R01HL135219, R01HL136660, and U54HL143541.

Dr. Perez receives support from US NIH, National Heart, Lung, and Blood Institute grant R01HL136390.

Dr. Piccini's time is supported by R01HL128595 from the National Heart, Lung and Blood Institute.

Dr. Schnabel receives funding from the European Unions Horizon 2020 research and innovation programme under the grant agreement No.847770 AFFECT-EU, the European Research Council (ERC) under the European Union's Horizon 2020 research and innovation programme (grant agreement No 648131), and ERACoSysMed3 (031L0239), and German Center for Cardiovascular Research (DZHK e.V.) (81Z1710103).

Dr. Turakhia reports support from R01DK095024 from the National Institute of Diabetes and Digestive and Kidney Diseases and the American Heart Association.

Note to Editors: Disclosures

Dr. Benjamin is an uncompensated member for the MyHeartLab Steering Committee, which is a PI-16initiated (Jeffrey Olgin, MD) research grant to UCSF from Samsung.

Dr. Go has received a research grant through his institution from iRhythm Technologies. Dr. Go is also a member of the Operations Committee and Steering Committee for the GUARD-AF Study (NCT04126486) sponsored by Bristol Meyers Squibb and Pfizer.

Dr. Anderson receives sponsored research support from Massachusetts General Hospital, and Bayer AG, and has consulted for ApoPharma, Inc.

Dr. Casadei is supported by a Personal Chair. She receives in kind support (in the form of free assays and ECG monitors) from Roche Diagnostics and iRhythm.

Dr. Crijns receives unrestricted grant support from Medtronic Trading NL B.V. 18

Dr Freedman reports grants to the institution, personal fees and non-financial support from Bayer Pharma AG, grants to the institution and personal fees from BMS/Pfizer, and personal fees from Daiichi-Sankyo and Omron.

Dr. van Gelder reports unrestricted grant support from Medtronic Trading NL B.V.

Dr. Healy reports research grants and speaking fees from Medtronic, Boston Scientific, Abbott, BMS/Pfizer, Servier, Cipher Pharma, and ARCA Biopharm. Also, supported by the Stuart Connolly Chair in Cardiology Research, McMaster University.

Dr. Kamel serves as co-PI for the NIH-funded ARCADIA trial which receives in-kind study drug from the BMS-Pfizer Alliance and in-kind study assays from Roche Diagnostics, serves as a steering committee member of Medtronic's Stroke AF trial (uncompensated), serves on an endpoint adjudication committee for a trial of empagliflozin for Boehringer-Ingelheim, and has served on an advisory board for Roivant Sciences related to Factor XI inhibition.

Dr. Lopes reported research grants and personal fees from Bristol-Myers Squibb and Pfizer, personal fees from Boehringer Ingelheim and Bayer AG and grants from Amgen Inc, GlaxoSmithKline, Medtronic PLC, and Sanofi Aventis. Dr. Lopes is also a member of the Operations Committee and Steering Committee for the GUARD-AF Study (NCT04126486) sponsored by Bristol Meyers Squibb and Pfizer.

Dr. Lubitz receives sponsored research support from Bristol Myers Squibb / Pfizer, Bayer AG, Boehringer Ingelheim, and Fitbit, and has consulted for Bristol Myers Squibb / Pfizer and Bayer AG, and participates in a research collaboration with IBM.

Dr. McManus's has received research support from Bristol Myers Squibb, Care Evolution, Samsung, Apple Computer, Pfizer, Biotronik, Boehringer Ingelheim, Philips Research Institute, Flexcon, Fitbit, and has consulted for Bristol Myers Squibb, Pfizer, Philips, Samsung Electronics, Fitbit, Rose Consulting, Boston Biomedical Associates, and FlexCon. DDM is also a member of the Operations Committee and Steering Committee for the GUARD-AF Study (NCT04126486) sponsored by Bristol Meyers Squibb and Pfizer as well as the Steering Committee of the Fitbit Heart Study (NCT04380415).

Dr. Perez is co-Principal Investigator of the Apple Heart Study funded by Apple Inc.; Dr. Perez has received consulting fees from Apple Inc. and Boehringer Ingelheim. Dr. Piccini receives grants for clinical research from Abbott, Association for the Advancement of Medical Instrumentation, Bayer, Boston Scientific, and Philips and serves as a consultant to Abbott, Allergan, ARCA Biopharma, Biotronik, Boston Scientific, LivaNova, Medtronic, Milestone, Myokardia, Sanofi, Philips, and Up-to-Date.

Dr. Schnabel reports speaking fees from Bristol-Myers Squibb/Pfizer.

Dr. Singer reports research support from Bristol-Myers Squibb; Steering committee/advisory board/consulting for Boehringer Ingelheim, Bristol-Myers Squibb, Fitbit, Johnson and Johnson, Merck, and Pfizer.

Dr. Tieleman reports grants and speaking fees from Boehringer Ingelheim, speaking fees from BMS/ Pfizer, speaking fees from Bayer, grants from Medtronic, grants from St Jude Medical, outside the submitted work. In addition, Dr. Tieleman has a patent as a co-inventor of the MyDiagnostick issued.

Dr. Turakhia reports grants from Bristol Myers Squibb, Apple, Janssen, Boehringer-Ingelheim, American Heart Association, Medtronic, Bayer; consulting fees from Medtronic, Myokardia, Biotronik, Pfizer, Johnson & Johnson; royalties from Up-to-Date. Dr. Turakhia is an editor for JAMA Cardiology. Dr. Turakhia is also a member of the Executive Committee for the HEARTLINE Study sponsored by Janssen Inc. SMA-K: consulting fees from Milestone Pharmaceuticals, research, speaking and consulting fees from Medtronic, research and speaking fees from Abbott, and speaking fees from BristolMyers Squibb/Pfizer.

Boston University School of Medicine

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