Early diagnosis and better rhythm management to improve outcomes in patients with atrial fibrillation: the 8th AFNET/EHRA consensus conference

doi:10.1093/europace/euac062

. 2023 Feb 8;25(1):6-27.

doi: 10.1093/europace/euac062.

Early diagnosis and better rhythm management to improve outcomes in patients with atrial fibrillation: the 8th AFNET/EHRA consensus conference

Renate B Schnabel^{1

2

3}, Elena Andreassi Marinelli⁴, Elena Arbelo^{5

6

7}, Giuseppe Boriani⁸, Serge Boveda^{9

10}, Claire M Buckley¹¹, A John Camm¹², Barbara Casadei¹³, Winnie Chua¹⁴, Nikolaos Dagres¹⁵, Mirko de Melis¹⁶, Lien Desteghe^{17

18

19

20}, Søren Zöga Diederichsen²¹, David Duncker²², Lars Eckardt^{1

23}, Christoph Eisert²⁴, Daniel Engler^{2

3}, Larissa Fabritz^{1

2

3

14

25}, Ben Freedman²⁶, Ludovic Gillet²⁷, Andreas Goette^{1

28}, Eduard Guasch^{5

6

7}, Jesper Hastrup Svendsen^{21

29}, Stéphane N Hatem³⁰, Karl Georg Haeusler^{1

31}, Jeff S Healey³², Hein Heidbuchel^{17

18}, Gerhard Hindricks^{1

15}, F D Richard Hobbs³³, Thomas Hübner²⁴, Dipak Kotecha³⁴, Michael Krekler³⁵, Christophe Leclercq³⁶, Thorsten Lewalter^{1

37

38}, Honghuang Lin³⁹, Dominik Linz^{40

41}, Gregory Y H Lip^{42

43}, Maja Lisa Løchen⁴⁴, Wim Lucassen⁴⁵, Katarzyna Malaczynska-Rajpold⁴⁶, Steffen Massberg^{47

48}, Jose L Merino⁴⁹, Ralf Meyer⁵⁰, Lluıs Mont^{5

6

7}, Michael C Myers³⁵, Lis Neubeck⁴⁹, Teemu Niiranen^{50

51}, Michael Oeff¹, Jonas Oldgren⁵², Tatjana S Potpara⁵³, George Psaroudakis⁵⁴, Helmut Pürerfellner⁵⁵, Ursula Ravens^{1

56}, Michiel Rienstra⁵⁷, Lena Rivard⁵⁸, Daniel Scherr⁵⁹, Ulrich Schotten^{1

60}, Dipen Shah⁶¹, Moritz F Sinner^{1

45

46}, Rüdiger Smolnik⁴, Gerhard Steinbeck^{1

62}, Daniel Steven^{1

63}, Emma Svennberg⁶⁴, Dierk Thomas^{1

65

66

67}, Mellanie True Hills⁶⁸, Isabelle C van Gelder⁶⁹, Burcu Vardar⁵⁴, Elena Palà⁷⁰, Reza Wakili^{1

71}, Karl Wegscheider^{1

3

72}, Mattias Wieloch^{73

74}, Stephan Willems^{1

3

75}, Henning Witt⁷⁶, André Ziegler²⁷, Matthias Daniel Zink⁷⁷, Paulus Kirchhof^{1

2

3

14}

Affiliations

¹ Atrial Fibrillation Network (AFNET), Muenster, Germany.
² Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
³ German Centre for Cardiovascular Research (DZHK) partner site Hamburg/Kiel/Lübeck, Hamburg, Germany.
⁴ Daiichi Sankyo Europe, Munich, Germany.
⁵ Arrhythmia Section, Cardiology Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain.
⁶ IDIBAPS, Institut d'Investigació August Pi i Sunyer, Barcelona, Spain.
⁷ CIBERCV, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain.
⁸ Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Polyclinic of Modena, Modena, Italy.
⁹ Cardiology-Heart Rhythm Management Department, Clinique Pasteur, 45 Avenue de Lombez, 31076 Toulouse, France.
¹⁰ Universiteit Ziekenhuis, Vrije Universiteit Brussel (VUB), Brussels, Belgium.
¹¹ School of Public Health, University College Cork, Cork, Ireland.
¹² Cardiology Clinical Academic Group, Molecular and Clinical Sciences Institute, St. George's University of London, London, UK.
¹³ RDM, Division of Cardiovascular Medicine, British Heart Foundation Centre of Research Excellence, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK.
¹⁴ Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.
¹⁵ Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany.
¹⁶ Medtronic Bakken Research Center, Maastricht, The Netherlands.
¹⁷ Research Group Cardiovascular Diseases, University of Antwerp, Antwerp, Belgium.
¹⁸ Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium.
¹⁹ Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.
²⁰ Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium.
²¹ Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.
²² Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.
²³ Division of Electrophysiology, Department of Cardiology and Angiology, Münster, Germany.
²⁴ Preventicus, Jena, Germany.
²⁵ University Center of Cardiovascular Science Hamburg, Hamburg, Germany.
²⁶ Heart Research Institute, The University of Sydney, Sydney, Australia.
²⁷ Roche Diagnostics, Basel, Switzerland.
²⁸ St Vincenz Hospital, Paderborn, Germany.
²⁹ Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
³⁰ IHU ICAN, Sorbonne-Universite, Paris, France.
³¹ Department of Neurology, Universitätsklinikum Würzburg, Würzburg, Germany.
³² Population Health Research Institute, McMaster University Hamilton, ON, Canada.
³³ Oxford Primary Care, University of Oxford, Oxford, UK.
³⁴ University of Birmingham & University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
³⁵ Bristol Myers Squibb, New York, NY, USA.
³⁶ Department of Cardiology, University Rennes, Rennes, France.
³⁷ Hospital Munich South, Department of Cardiology, Munich, Germany.
³⁸ Department of Cardiology, University of Bonn, Bonn, Germany.
³⁹ Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA.
⁴⁰ Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands.
⁴¹ Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
⁴² Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.
⁴³ Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
⁴⁴ Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
⁴⁵ Amsterdam UMC (location AMC), Department General Practice, Amsterdam, The Netherlands.
⁴⁶ Royal Brompton Hospital, London, UK.
⁴⁷ Department of Cardiology, University Hospital, LMU Munich, Munich, Germany.
⁴⁸ German Centre for Cardiovascular Research (DZHK), partner site: Munich Heart Alliance, Munich, Germany.
⁴⁹ Arrhythmia & Robotic EP Unit, La Paz University Hospital, IDIPAZ, Madrid, Spain.
⁵⁰ Medtronic, Dublin, Ireland.
⁵¹ Centre for Cardiovascular Health Edinburgh Napier University, Edinburgh, UK.
⁵² University of Turku and Turku University Hospital, Turku, Finland.
⁵³ National Institute for Health and Welfare, Helsinki, Finland.
⁵⁴ Uppsala Clinical Research Center and Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
⁵⁵ School of Medicine, Belgrade University, Cardiology Clinic, University Clinical Centre of Serbia, Belgrade, Serbia.
⁵⁶ Bayer AG, Leverkusen, Germany.
⁵⁷ Ordensklinikum Linz, Elisabethinen, Cardiological Department, Linz, Austria.
⁵⁸ Institute of Experimental Cardiovascular Medicine, University Hospital Freiburg, Freiburg, Germany.
⁵⁹ Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
⁶⁰ Montreal Heart Institute, University of Montreal, Montreal, Canada.
⁶¹ Division of Cardiology, Medical University of Graz, Graz, Austria.
⁶² MUMC+, Maastricht, The Netherlands.
⁶³ University Hospital of Geneva, Cardiac Electrophysiology Unit, Geneva, Switzerland.
⁶⁴ Center for Cardiology at Clinic Starnberg, Starnberg, Germany.
⁶⁵ University Hospital Cologne, Heart Center, Department of Electrophysiology, Cologne, Germany.
⁶⁶ Karolinska Institutet, Department of Medicine Huddinge, Karolinska University Hospital, Stockholm, Sweden.
⁶⁷ Department of Cardiology, Medical University Hospital, Heidelberg, Germany.
⁶⁸ HCR (Heidelberg Center for Heart Rhythm Disorders), Medical University Hospital Heidelberg, Heidelberg, Germany.
⁶⁹ DZHK (German Center for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg, Germany.
⁷⁰ StopAfib.org, American Foundation for Women's Health, Decatur, TX, USA.
⁷¹ Department of Cardiology, University Medical Center Groningen, University of Groningen, The Netherlands.
⁷² Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR), Autonomous University of Barcelona, Barcelona, Spain.
⁷³ Department of Cardiology and Vascular Medicine, Westgerman Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany.
⁷⁴ Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Germany.
⁷⁵ Department of Coagulation Disorders, Skane University Hospital, Lund University, Malmö, Sweden.
⁷⁶ Sanofi, Paris, France.
⁷⁷ Asklepios Hospital St Georg, Department of Cardiology and Internal Intensive Care Medicine, Faculty of Medicine, Semmelweis University Campus Hamburg, Hamburg, Germany.

PMID: 35894842
PMCID: PMC9907557
DOI: 10.1093/europace/euac062

Early diagnosis and better rhythm management to improve outcomes in patients with atrial fibrillation: the 8th AFNET/EHRA consensus conference

Renate B Schnabel et al. Europace. 2023.

. 2023 Feb 8;25(1):6-27.

doi: 10.1093/europace/euac062.

Authors

Affiliations

¹ Atrial Fibrillation Network (AFNET), Muenster, Germany.
² Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
³ German Centre for Cardiovascular Research (DZHK) partner site Hamburg/Kiel/Lübeck, Hamburg, Germany.
⁴ Daiichi Sankyo Europe, Munich, Germany.
⁵ Arrhythmia Section, Cardiology Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain.
⁶ IDIBAPS, Institut d'Investigació August Pi i Sunyer, Barcelona, Spain.
⁷ CIBERCV, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain.
⁸ Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Polyclinic of Modena, Modena, Italy.
⁹ Cardiology-Heart Rhythm Management Department, Clinique Pasteur, 45 Avenue de Lombez, 31076 Toulouse, France.
¹⁰ Universiteit Ziekenhuis, Vrije Universiteit Brussel (VUB), Brussels, Belgium.
¹¹ School of Public Health, University College Cork, Cork, Ireland.
¹² Cardiology Clinical Academic Group, Molecular and Clinical Sciences Institute, St. George's University of London, London, UK.
¹³ RDM, Division of Cardiovascular Medicine, British Heart Foundation Centre of Research Excellence, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK.
¹⁴ Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.
¹⁵ Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany.
¹⁶ Medtronic Bakken Research Center, Maastricht, The Netherlands.
¹⁷ Research Group Cardiovascular Diseases, University of Antwerp, Antwerp, Belgium.
¹⁸ Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium.
¹⁹ Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.
²⁰ Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium.
²¹ Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.
²² Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.
²³ Division of Electrophysiology, Department of Cardiology and Angiology, Münster, Germany.
²⁴ Preventicus, Jena, Germany.
²⁵ University Center of Cardiovascular Science Hamburg, Hamburg, Germany.
²⁶ Heart Research Institute, The University of Sydney, Sydney, Australia.
²⁷ Roche Diagnostics, Basel, Switzerland.
²⁸ St Vincenz Hospital, Paderborn, Germany.
²⁹ Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
³⁰ IHU ICAN, Sorbonne-Universite, Paris, France.
³¹ Department of Neurology, Universitätsklinikum Würzburg, Würzburg, Germany.
³² Population Health Research Institute, McMaster University Hamilton, ON, Canada.
³³ Oxford Primary Care, University of Oxford, Oxford, UK.
³⁴ University of Birmingham & University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
³⁵ Bristol Myers Squibb, New York, NY, USA.
³⁶ Department of Cardiology, University Rennes, Rennes, France.
³⁷ Hospital Munich South, Department of Cardiology, Munich, Germany.
³⁸ Department of Cardiology, University of Bonn, Bonn, Germany.
³⁹ Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA.
⁴⁰ Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands.
⁴¹ Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
⁴² Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.
⁴³ Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
⁴⁴ Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
⁴⁵ Amsterdam UMC (location AMC), Department General Practice, Amsterdam, The Netherlands.
⁴⁶ Royal Brompton Hospital, London, UK.
⁴⁷ Department of Cardiology, University Hospital, LMU Munich, Munich, Germany.
⁴⁸ German Centre for Cardiovascular Research (DZHK), partner site: Munich Heart Alliance, Munich, Germany.
⁴⁹ Arrhythmia & Robotic EP Unit, La Paz University Hospital, IDIPAZ, Madrid, Spain.
⁵⁰ Medtronic, Dublin, Ireland.
⁵¹ Centre for Cardiovascular Health Edinburgh Napier University, Edinburgh, UK.
⁵² University of Turku and Turku University Hospital, Turku, Finland.
⁵³ National Institute for Health and Welfare, Helsinki, Finland.
⁵⁴ Uppsala Clinical Research Center and Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
⁵⁵ School of Medicine, Belgrade University, Cardiology Clinic, University Clinical Centre of Serbia, Belgrade, Serbia.
⁵⁶ Bayer AG, Leverkusen, Germany.
⁵⁷ Ordensklinikum Linz, Elisabethinen, Cardiological Department, Linz, Austria.
⁵⁸ Institute of Experimental Cardiovascular Medicine, University Hospital Freiburg, Freiburg, Germany.
⁵⁹ Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
⁶⁰ Montreal Heart Institute, University of Montreal, Montreal, Canada.
⁶¹ Division of Cardiology, Medical University of Graz, Graz, Austria.
⁶² MUMC+, Maastricht, The Netherlands.
⁶³ University Hospital of Geneva, Cardiac Electrophysiology Unit, Geneva, Switzerland.
⁶⁴ Center for Cardiology at Clinic Starnberg, Starnberg, Germany.
⁶⁵ University Hospital Cologne, Heart Center, Department of Electrophysiology, Cologne, Germany.
⁶⁶ Karolinska Institutet, Department of Medicine Huddinge, Karolinska University Hospital, Stockholm, Sweden.
⁶⁷ Department of Cardiology, Medical University Hospital, Heidelberg, Germany.
⁶⁸ HCR (Heidelberg Center for Heart Rhythm Disorders), Medical University Hospital Heidelberg, Heidelberg, Germany.
⁶⁹ DZHK (German Center for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg, Germany.
⁷⁰ StopAfib.org, American Foundation for Women's Health, Decatur, TX, USA.
⁷¹ Department of Cardiology, University Medical Center Groningen, University of Groningen, The Netherlands.
⁷² Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR), Autonomous University of Barcelona, Barcelona, Spain.
⁷³ Department of Cardiology and Vascular Medicine, Westgerman Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany.
⁷⁴ Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Germany.
⁷⁵ Department of Coagulation Disorders, Skane University Hospital, Lund University, Malmö, Sweden.
⁷⁶ Sanofi, Paris, France.
⁷⁷ Asklepios Hospital St Georg, Department of Cardiology and Internal Intensive Care Medicine, Faculty of Medicine, Semmelweis University Campus Hamburg, Hamburg, Germany.

PMID: 35894842
PMCID: PMC9907557
DOI: 10.1093/europace/euac062

Abstract

Despite marked progress in the management of atrial fibrillation (AF), detecting AF remains difficult and AF-related complications cause unacceptable morbidity and mortality even on optimal current therapy. This document summarizes the key outcomes of the 8th AFNET/EHRA Consensus Conference of the Atrial Fibrillation NETwork (AFNET) and the European Heart Rhythm Association (EHRA). Eighty-three international experts met in Hamburg for 2 days in October 2021. Results of the interdisciplinary, hybrid discussions in breakout groups and the plenary based on recently published and unpublished observations are summarized in this consensus paper to support improved care for patients with AF by guiding prevention, individualized management, and research strategies. The main outcomes are (i) new evidence supports a simple, scalable, and pragmatic population-based AF screening pathway; (ii) rhythm management is evolving from therapy aimed at improving symptoms to an integrated domain in the prevention of AF-related outcomes, especially in patients with recently diagnosed AF; (iii) improved characterization of atrial cardiomyopathy may help to identify patients in need for therapy; (iv) standardized assessment of cognitive function in patients with AF could lead to improvement in patient outcomes; and (v) artificial intelligence (AI) can support all of the above aims, but requires advanced interdisciplinary knowledge and collaboration as well as a better medico-legal framework. Implementation of new evidence-based approaches to AF screening and rhythm management can improve outcomes in patients with AF. Additional benefits are possible with further efforts to identify and target atrial cardiomyopathy and cognitive impairment, which can be facilitated by AI.

Keywords: AFNET; Anticoagulation; Artificial intelligence; Atrial cardiomyopathy; Atrial fibrillation; Bleeding; Catheter ablation; Cognitive function; Consensus statement; Cost; Dementia; EHRA; Guidelines; Heart failure; Integrated care; Outcomes; Quality of care; Research; Research priorities; Rhythm management; Screening; Stroke; Technology.

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Conflict of interest statement

Conflict of interest: RBS has received lecture fees and advisory board fees from BMS/Pfizer outside this work and has received funding from the European Research Council (ERC) under the European Union's Horizon 2020 research and innovation programme under the grant agreement No 648131, from the European Union's Horizon 2020 research and innovation programme under the grant agreement No 847770 (AFFECT-EU) and German Center for Cardiovascular Research (DZHK e.V.) (8121710103); German Ministry of Research and Education (BMBF 01ZX1408A) and ERACoSysMed3 (031L0239).EAM is employee of Daiichi Sankyo Europe GmbH producing and marketing an oral anticoagulant (edoxaban). EA has received consulting / speaker fees for Biosense Webster. GB has received speaker's fees of small amount from Boston, Bayer, Daiichi, Boehringer. SB is consultant for Medtronic, Boston Scientific, Microport, and Zoll. JC has received consulting fees / honoraria fees from Acesion, Allergan, Alta Thera, Arca, lncarda, Menarini, Milestone, Sanofi, Bayer, Daiichi Sankyo, Pfizer, Abbott, Biosense Webster, Biotronik, Boston Scientific, Lilly, Medtronic, Johnson and Johnson. BC has received in kind contribution for research Support from iRhythm. WC has received advisory board fees for Roche Diagnostics AG. MDM is employee of Medtronic. SZB has received fees as member of Advisory Board in Bristol Myers Squibb-Pfizer. DD has received fees from Abbott, Astra Zenica, Bayer, Bosten Scientific, Bristol Myers Squibb-Pfizer, Medtonic, Zoll. LE has received lecture Honoria from Medtronic, Biotronik, Boston Scientific, Boehringer Ingelheim, Daiichy Sankyo, Bayer, MMS, Pfizer, Sanofi and received research grants from DFG and DGK. CE is employee of Preventicus GmbH. LF has received institutional research grants and non-financial support from European Union, DFG, British Heart Foundation, Medical Research Council (UK), NIHR, and several biomedical companies. The Institute of Cardiovascular Research, University of Birmingham, has received an Accelerator Award by the British Heart Foundation M/18/2/34218. LF is listed as inventor of two patents held by University of Birmingham (Atrial Fibrillation Therapy WO 2015140571, Markers for Atrial Fibrillation WO 2016012783). BF receiving fees from Bristol-Myers Squibb and Pfizer Alliance, Bayer, Daiichi Sankyo, Omron. (largely speaker fees and travel support for speaking at session or official satellites of large international/continental society meetings) and investigator-initiated research grants to the institution from Bristol-Myers and Squibb and Pfizer Alliance and Ownership / Employee of Nil. LG and AZ are employees of Roche Diagnostics International Ltd. AG has received funding from Daiichi Sankyo, Astra Zenica, Bayer, Bristol Myers Squibb-Pfizer, Viola, Medtonic, Berlin Charitè. JHS has received Advisory board fees in Medtronic and Speaker fee from Medtronic. KGH has received fees from Abbott, Alexion, AMARIN, AstraZeneca, Bayer, Biotronik, Boehringer Ingelheim, Bristol-Myers-Squibb, Daiichi Sankyo, Edwards Lifesciences, Medtronic, Pfizer, Premier Research, SUN Pharma and W. L. Gare & Associates and Research Grants from Bayer Vital, Sanofi-Aventis. JSH received fees from Boston Scientific, Servier, Bayer, Myokardia, Bristol-Myers-Squibb, Pfizer, and research grants from Medtronic, Boston Scientific, Bristol-Myers-Squibb, Abbott. HH has received lecture and consultancy fees from Abbott, Biotronik, Bristol-Myers-Squibb- Pfizer, Medscape, Daiichi Sankyo, Springer Healthcare Ltd and receive un conditional research grants through the Univerity of Antwerp and/or University of Hasselt from Abbott, Bayer, Biotronik, Biosense-Webster, Fibrickeck/Qompium, Medtronic, Bristol-Myers-Squibb- Pfizer, Boston Scientific, Daiichi Sankyo and Boehringer Ingelheim. RH has received speacker fees from BI, Bayer and Bristol-Myers-Squibb- Pfizer and AZ. TH is CEO of Preventicus GmbH. DK has received funding from Bayer, AtriCure, Protherics Medicines Development and Myokardia and Research grant from rants from the National Institute for Health Research (NIHR CDF-2015-08-074 RATE-AF; NIHR HTA-130280 DaRe2THINK; NIHR EME- 132974 D2T-NV), the British Heart Foundation (PG/17/55/33087 and AA/18/2/34218), EU/EFPIA IMI (BigData@Heart 116074),the European Society of Cardiology supported by educationalgrants from Boehringer Ingelheim/BMS-Pfizer Alliance/Bayer/Daiichi Sankyo/Boston Scientific, the NIHR/the University of Ox- ford Biomedical Research Centre, and British Heart Foundation/ the University of Birmingham Accelerator Award (STEEER-AF NCT04396418), Amomed Pharma, and IRCCS San Raffaele/Menarini (beta-blockers in Heart Failure Collaborative Group NCT0083244). MK is employee of Bristol-Myers and Squibb. CL has received fees from medtonic, Boston Scientific, Biotronik and Bristol-Myers and Squibb- Pfizer and research grants from Rennes Univerity, Metronik, Biotonik and Boston Scientific. DL has received research grant for EHRA-PATHS, NovoNordisk Young Investigator Award. MLL has received lecture fees from Bristol-Myers and Squibb and research grant from H2020 AFFECT-EU (grant No. 847770). SM has received research grant from Daiichi Sankyo (EPDAURUS IIT) and Bristol-Myers and Squibb (APPROACH ACS AF IIT). JLM has received Abbott, Boston Scientific, Biotronik, Boehringer Ingelheim, Sanofi, Microport and received research grants from Medtronic, Abbott, Microport, Biosense. RM is employee of Medtronic. LM is Stockholder for Galgomedical and Corify and receiving consuting fees from Abbott, Biosense-Webster, Bosten Scientific, Medtronik and receiving research grants from Abbott, Biosense-Webster, Bosten Scientific, Medtronik. LN has received consulting fees from Bristol-Myers and Squibb- Pfizer. GP is employee of Bayer AG. HP has received consulting fees from Abbott, Biosense-Webster, Bosten Scientific, Medtronik and receiving research grants from Abbott, Bayer, Biosense-Webster, Bosten Scientific, Medtronik, Bristol-Myers and Squibb- Pfizer. MR has received consulting fees for Medtonic, Arca BiopharmaInc, Roche and received research grants from Dutch Heart Foundation: RACE V, RED-CVD, CVON-AI, DECISION studies; grant from SJM/Abbott to institution: VIP-HF study; Grant for Medtronic to institution: Cryoballoon AF registry/biobank study. The other authors declare that there is no conflict of interest.LR has received research grants from Canadian Insititute of Health research and Byer Inc. U.S. received consultancy fees or honoraria from Università della Svizzera Italiana (USI, Switzerland), Roche Diagnostics (Switzerland), EP Solutions Inc. (Switzerland), Johnson & Johnson Medical Limited, (United Kingdom), Bayer Healthcare (Germany). U.S. is co-founder and shareholder of YourRhythmics BV, a spin-off company of the University Maastricht and Research grant from the Dutch Heart Foundation (CVON RACE V, CVON2014–09) European Union's Horizon 2020 Research and Innovation Program granted to MS under the Marie Sklodowska-Curie grant agreement #813716 (TRAIN-HEART Innovative Training Network), and various other programs of the European Union granted to US (ITN Network Personalize AF: Personalized Therapies for Atrial Fibrillation: a translational network – grant #860974; CATCH ME: Characterizing Atrial fibrillation by Translating its Causes into Health Modifiers in the Elderly – grant #633196; MAESTRIA: Machine Learning Artificial Intelligence Early Detection Stroke Atrial Fibrillation – grant #965286; REPAIR: Restoring cardiac mechanical function by polymeric artificial muscular tissue – grant #952166). DS has received consultation fees from Biosense Webster, Abbott, Boston Scientific, Consultant with stock option: SentiAR, Arga Medtech. RS is employee of Daiichi Sankyo Europe GmbH. DS has received consultation fees from Boston Scientific, Abbott and Research grant from Biosense Webster. ES has received lecture fees from Bayer, Bristol-Myers and Squibb- Pfizer, Boehringer Ingelheim, Johnson & Johnson, Merck Sharp & Dohme and Sanofi. DT has received lecture fees from Bayer Vital, Bristol-Myers and Squibb- Pfizer, Daiichi Sankyo, Medtonic, Zoll CMS, Sanofi, St. Jude Medical and research grant from Daiichi Sankyo. MTH is employee/owner of American Foundation of women's Health /StopAfib.org and employee/owner of True Hills Inc.. BV is employee of Bayer AG. RW has received consultation fees from Boston Scientific, Biotronic, Pfizer, Daiichi Sankyo, Bayer, Adagio Medical and Research grant from Bristol-Myers and Squibb- Pfizer, Boston Scientific. CW has received consulation fees from Biotronik, Boston Scientific, Novartis and research grant from BMBF, AFNET, DZHK, Biotronik. MW is employee and shareholder of Sanofi. SW has received Consulting fees from Boston Scientific, Abbott, Bayer, Bristol-Myers and Squibb- Pfizer, Boehringer Ingelheim and research grant from Boston Scientific. HW is employee and stockholder of Pfizer Germany. MDZ has received advisory and speaker fee from Bristol-Myers and Squibb- Pfizer. PK reports grants and non-financial support from BMBF (German Ministry of Education and Research), grants from Sanofi and Abbott, grants and non-financial support from EHRA (European Heart Rhythm Association), and grants from German Heart Foundation and DZHK (German Center for Cardiovascular Research), during the conduct of the study, and grants from European Union, British Heart Foundation, Leducq Foundation, Medical Research Council (UK), and non-financial support from German Centre for Heart Research, outside the submitted work; in addition, P.K. has a patent Atrial Fibrillation Therapy WO 2015140571 issued to University of Birmingham and a patent Markers for Atrial Fibrillation WO 2016012783 issued to University of Birmingham.

Figures

**Figure 1**
Suggested systematic screening pathway and entry of consumer-led screening into the systematic screening pathway. The scores comprise congestive HF, hypertension, age ≥75 years, DM, stroke, vascular disease, age 65–74 years, sex category (female) (CHA₂DS₂-VASc score) and hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile INR (international normalized ratio), elderly (>65 years), drugs/alcohol concomitantly (HAS-BLED). Consider HAS-BLED to minimize bleeding risk. DM, diabetes mellitus; ECG, electrocardiogram; HF, heart failure; LEAD, lower extremity arterial disease; MI, myocardial infarction; NT-proBNP, N-terminal pro-B-type natriuretic peptide; PPG, photoplethysmography; TIA, transient ischaemic attack; SR, sinus rhythm.

**Figure 2**
Suggested A–B–C pathway for recently diagnosed AF. *LAAO is a potential option for selected patients with absolute contraindication for oral anticoagulation. LAAO, left atrial appendage occlusion; NOAC, non-vitamin K antagonist oral anticoagulant; VKA, vitamin K antagonist.

**Figure 3**
Lifelong AF management incorporating anticoagulation, rhythm management, and concomitant conditions. AAD, antiarrhythmic drugs; AF, atrial fibrillation.

**Figure 4**
Flow chart on three common presentations of AF and cognitive impairment (or dementia): (i) a patient presenting with known AF whose mental state is not the reason for the presentation, (ii) a patient with known cognitive impairment, and (iii) a patient with both, known AF and cognitive impairment. For the patient with known AF, simple tests of cognitive function may confirm the need for detailed assessment to evaluate the cause of cognitive impairment and initiate therapy for reversible causes. Similarly, patients presenting with cognitive impairment should undergo opportunistic screening for AF (pulse palpation eventually followed by an ECG) and, if AF is discovered, it should be assessed and managed initially by a specialist following the A–B–C (Atrial fibrillation Better Care [includes A (avoid stroke), B (better symptom control), C (cardiovascular risk factors and comorbid conditions management)] scheme recommended by the European Society of Cardiology. AF, atrial fibrillation; MMSE, Mini-Mental State Examination; MoCA, Montreal Cognitive Assessment; MRI, magnetic resonance imaging; NOAC, non-vitamin K oral anticoagulant; OAC, oral anticoagulant.

**Figure 5**
Atrial cardiomyopathy and its possible phenotypes: AF and atrial high rate episodes. Different potential quantification measures and their sensitivity for detection of atrial cardiomyopathy depending on the extent of impairment.

**Figure 6**
Framework to deliver quality of care detailing a structured pathway for quality of care (left) and determinants of structured quality of care assessment (right).

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References

1. Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomstrom-Lundqvist C, et al. . 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): the task force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J 2021;42:373–498. - PubMed
1. Nabauer M, Oeff M, Gerth A, Wegscheider K, Buchholz A, Haeusler KGet al. . Prognostic markers of all-cause mortality in patients with atrial fibrillation: data from the prospective long-term registry of the German Atrial Fibrillation NETwork (AFNET). Europace 2021;23:1903–12. - PubMed
1. Singer DE, Ziegler PD, Koehler JL, Sarkar S, Passman RS. Temporal association between episodes of atrial fibrillation and risk of ischemic stroke. JAMA Cardiol 2021;6:1364–9. - PMC - PubMed
1. Kirchhof P, Camm AJ, Goette A, Brandes A, Eckardt L, Elvan A, et al. . Early rhythm-control therapy in patients with atrial fibrillation. N Engl J Med 2020;383:1305–16. - PubMed
1. Freedman B, Camm J, Calkins H, Healey JS, Rosenqvist M, Wang J, et al. . Screening for atrial fibrillation: a report of the AF-SCREEN international collaboration. Circulation 2017;135:1851–67. - PubMed

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[1] Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomstrom-Lundqvist C, et al. . 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): the task force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J 2021;42:373–498. - PubMed

[2] Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomstrom-Lundqvist C, et al. . 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): the task force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J 2021;42:373–498. - PubMed

[3] Nabauer M, Oeff M, Gerth A, Wegscheider K, Buchholz A, Haeusler KGet al. . Prognostic markers of all-cause mortality in patients with atrial fibrillation: data from the prospective long-term registry of the German Atrial Fibrillation NETwork (AFNET). Europace 2021;23:1903–12. - PubMed

[4] Nabauer M, Oeff M, Gerth A, Wegscheider K, Buchholz A, Haeusler KGet al. . Prognostic markers of all-cause mortality in patients with atrial fibrillation: data from the prospective long-term registry of the German Atrial Fibrillation NETwork (AFNET). Europace 2021;23:1903–12. - PubMed

[5] Singer DE, Ziegler PD, Koehler JL, Sarkar S, Passman RS. Temporal association between episodes of atrial fibrillation and risk of ischemic stroke. JAMA Cardiol 2021;6:1364–9. - PMC - PubMed

[6] Singer DE, Ziegler PD, Koehler JL, Sarkar S, Passman RS. Temporal association between episodes of atrial fibrillation and risk of ischemic stroke. JAMA Cardiol 2021;6:1364–9. - PMC - PubMed

[7] Kirchhof P, Camm AJ, Goette A, Brandes A, Eckardt L, Elvan A, et al. . Early rhythm-control therapy in patients with atrial fibrillation. N Engl J Med 2020;383:1305–16. - PubMed

[8] Kirchhof P, Camm AJ, Goette A, Brandes A, Eckardt L, Elvan A, et al. . Early rhythm-control therapy in patients with atrial fibrillation. N Engl J Med 2020;383:1305–16. - PubMed

[9] Freedman B, Camm J, Calkins H, Healey JS, Rosenqvist M, Wang J, et al. . Screening for atrial fibrillation: a report of the AF-SCREEN international collaboration. Circulation 2017;135:1851–67. - PubMed

[10] Freedman B, Camm J, Calkins H, Healey JS, Rosenqvist M, Wang J, et al. . Screening for atrial fibrillation: a report of the AF-SCREEN international collaboration. Circulation 2017;135:1851–67. - PubMed

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Early diagnosis and better rhythm management to improve outcomes in patients with atrial fibrillation: the 8th AFNET/EHRA consensus conference

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Early diagnosis and better rhythm management to improve outcomes in patients with atrial fibrillation: the 8th AFNET/EHRA consensus conference

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