cyclingUrgent action is critical to lessening the potential impact of Atrial Fibrillation (AF) according to an expert report launched at the start of Heart Rhythm Week (1-7 June 2015). With an aging population in Europe and the prevalence of AF expected to double in the continent by 20602, AF looks likely to become a future health issue for millions of people in Europe. 

Researched and written by RAND Europe, with contributions from a panel of leading European medical, patient group and health economic experts, the Future of Anticoagulation Report explores how decisions made today can change and reshape the landscape of tomorrow and have the potential to make a significant difference in changing the direction of this disease in terms of prevalence and impact. The Future of Anticoagulation initiative was supported financially and in kind by Daiichi Sankyo Europe.

Atrial fibrillation, a disorder of the rhythm of the heart, is expected to be a leading health burden in the EU in the coming years. AF is the most common sustained arrhythmia in the general population affecting approximately 1.5-2% of the population in the developed world. A heart rhythm disorder may remain ‘silent’, asymptomatic and undiscovered for months or even years. However, its eventual consequences can be very damaging and are associated with significant morbidities and mortality. AF is associated with a five times higher risk of stroke and a three times higher risk of heart failure. Strokes that result from AF are more severe and are associated with a high risk of mortality (32.8%) and with a 50% probability of remaining disabled or handicapped within 3 months of having a stroke. Therefore, the increasing number of adults with AF will have major public health implications across Europe over the forthcoming decades. Although new medical therapies have been developed and recommendations for diagnosis and treatments aligned in Europe in the last few years, AF is still under or not treated in many cases.

The Future of Anticoagulation Report outlines three primary short-term recommendations; improve AF awareness amongst the public and policy makers, support education about AF management for healthcare professionals and patients, and maintain AF related research across the health services to be able to monitor what works best in terms of healthcare interventions.

“This report is a wake-up call for healthcare professionals and policy makers across Europe to work together to better manage AF, as its burden looks set to double as our population ages,” explains Professor John Camm, Chair of the Future of Anticoagulation Steering Committee, Professor of Clinical Cardiology, St. George’s, University of London and Professor of Cardiology, Imperial College London, United Kingdom. “I would especially like to highlight that we need to improve healthcare policies related to AF, including improving diagnosis and supporting earlier treatment interventions, such as effective modern anticoagulant medicines, to ensure that we can ultimately prevent avoidable deaths across the continent.”

The study aims were to assess the current landscape and challenges for the management of AF in Europe, and explore how this landscape could evolve. It focused on six key countries in Europe; Belgium, France, Germany, Italy, Spain and the UK. The two main goals of the study were to develop an evidence base on the current reality of AF-related anticoagulation management in these six countries and to develop an understanding of actions that could be taken today to improve the outlook for future AF management. The methods of research comprised a literature review and assessment, and 60 interviews carried out with a range of experts representing various stakeholder groups such as healthcare professionals, patient representatives and policymakers. In addition, a Steering Committee made up of 10 experts in cardiology and related areas from the six European focus countries and an international patient group representative were actively involved in the development of the report.

“Through the research we conducted and the insights gathered from the broader AF community, one overriding message has crystallised: there will be significant human and economic consequences in the coming years if clear steps are not taken now to stem the rising burden of atrial fibrillation,” commented Professor Joanna Chataway, Research Group Director, Innovation, Health and Science, RAND Europe.

Detecting an irregular heart rhythm might be as simple as a manual pulse check, with any unusual rhythm verified with an electrocardiogram (ECG). Trudie C. Lobban MBE, Founder & CEO of Atrial Fibrillation Association (AFA) explained, “Lives can be saved if only people begin to regularly check their pulse. Early diagnosis is more challenging if few people know about AF or its symptoms, and if AF goes undiagnosed, opportunities for earlier interventions and treatment to prevent AF-related stroke are missed entirely. The Atrial Fibrillation Association welcomes this timely report that underscores how important it is to Detect, Protect and Correct heart rhythm disorders across the EU.”

The report’s longer-term recommendations include: (i) taking a longer-term view in decisions on spending for AF awareness, education, care and management that are considered vital for improving health outcomes; (ii) there is a need for continued improvement in patient stratification (such as based on biomarkers or health imaging) that can lead to enhanced personalisation of treatment and medical care; (iii) there needs to be greater interaction among primary, community, secondary and tertiary healthcare professionals to enable greater knowledge sharing and more whole-patient approaches to care; and finally (iv) enhancing monitoring via developments in devices and data is also needed to maximise benefits of AF management.