The American College of Cardiology (ACC) and American Heart Association (AHA) just published new guidelines for the diagnosis and management of atrial fibrillation (AFib) that, among other things, embraced more aggressive treatments such as catheter ablation and left atrial appendage (LAA) occlusion.
The document, published in full in both the Journal of the American College of Cardiology and Circulation, covered significant ground.[1, 2] However, there are still many other AFib-related topics that needs to be explored.
In fact, the document’s authors concluded by sharing a list of 19 things they hope to see addressed in future AFib guidelines. Those topics included:
1. AFib as a disease continuum.
“AFib must be seen as a disease continuum, yet historically the emphasis has been on rhythm management,” wrote Jose Joglar, MD, head of the arrhythmia program at UT Southwestern Medical Center and chair of the document’s writing committee, and colleagues. “More evidence is needed on how to best improve in other aspects of AFib care, such as prevention, modification of risk factors, and how to incorporate holistic approaches to AFib management into daily clinical practice.”
2. The downstream consequences of AFib.
3. Improved definitions for goals, outcomes, etc.
4. How various risk factor modifications can impact stroke prevention.
5. Calculating a specific patient’s risk of AFib, stroke
6. Including a larger variety of risk scores
7. Learning more about the prospects of surgical LAA exclusion
“Increasingly available evidence has demonstrated the benefit of surgical LAA exclusion for stroke prevention, but the most scientifically rigorous trials included patients who received concomitant anticoagulation,” the group wrote. “More evidence is needed on the magnitude of benefit of LAA exclusion in preventing stroke in patients who have contraindications to anticoagulation and how to best manage those patients around rhythm-control interventions, such as cardioversion.”
8. When patients with subclinical AFib may face a heightened risk of adverse events.
9. The use of consumer-based wearable monitoring devices
10. The standardization of ablation procedures.
“Large registries and more data are required to better define standards of care in this field,” the group wrote. “Many interventions, such as extra ablation lines, are still performed despite limited data demonstrating efficacy, whereas the best approaches to persistent AF and repeat ablation are poorly defined.”
11. Selecting the best candidates for ablation.
12. Using AI to help manage AFib.
“Artificial intelligence could potentially be used to better tailor therapy to the individual patient, taking into consideration numerous factors that may better select candidates for therapeutic approaches, such as anticoagulation versus LAA occlusion, rhythm versus rate control, catheter ablation versus medical therapy, modification of risk factors, genetics and others,” the group wrote.
13. Various anticoagulation strategies
14. The relationship between AFib and sleep.
15. How shared decision-making and decision aids may impact outcomes.
16. The potential benefits of genetic testing for AFib.
17. Differences in AFib risk and treatment between different patient populations.
“In sexual- and gender-diverse individuals, additional research is recommended to identify the incidence and outcomes of AFib as well as the impact of gender-affirming therapies on arrhythmia incidence and outcomes,” the group wrote. “Additional data across racial and ethnic groups should also be encouraged.”
18. Standardized measures to provide clarity when discussing symptoms and the impact of various therapies.
19. How various social determinants of health may impact a patient’s AFib risk.
“The measurement and impact of social determinants of health in AFib is underutilized and understudied,” the group wrote.
Click here for more information about the ACC/AHA/ACCP/HRS guidelines.
Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.