Abstract
Clinically recognized atrial fibrillation (AF) is associated with higher risk of complications, including ischemic stroke, cognitive decline, heart failure, myocardial infarction, and death. It is increasingly recognized that AF frequently is undetected until complications such as stroke or heart failure occur. Hence, the public and clinicians have an intense interest in detecting AF earlier. However, the most appropriate strategies to detect undiagnosed AF (sometimes referred to as subclinical AF) and the prognostic and therapeutic implications of AF detected by screening are uncertain. Our report summarizes the National Heart, Lung, and Blood Institute's virtual workshop 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. Our report aims to inform and catalyze AF screening research that will advance innovative, resource-efficient, and clinically relevant studies in diverse populations to improve the diagnosis, management, and prognosis of patients with undiagnosed AF.
| Original language | English |
|---|---|
| Pages (from-to) | 372-388 |
| Number of pages | 17 |
| Journal | Circulation |
| Volume | 143 |
| Issue number | 4 |
| DOIs | |
| Publication status | Published - 26 Jan 2021 |
Keywords
- AUSTRALIAN CLINICAL GUIDELINES
- CARDIAC SOCIETY
- COMPREHENSIVE EVALUATION
- CRYPTOGENIC STROKE
- EHRA CONSENSUS DOCUMENT
- ORAL ANTICOAGULANTS
- PRIMARY-CARE
- RHYTHM MONITORING STRATEGIES
- SOCIEDAD LATINOAMERICANA
- TRANSIENT ISCHEMIC ATTACK
- atrial fibrillation
- diagnostic screening programs
- prevention and control
- research
- stroke
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In: Circulation, Vol. 143, No. 4, 26.01.2021, p. 372-388.
Research output: Contribution to journal › Article › Academic › peer-review
TY - JOUR
T1 - Research Priorities in Atrial Fibrillation Screening
T2 - A Report From a National Heart, Lung, and Blood Institute Virtual Workshop
AU - Benjamin, Emelia J.
AU - Go, Alan S.
AU - Desvigne-Nickens, Patrice
AU - Anderson, Christopher D.
AU - Casadei, Barbara
AU - Chen, Lin Y.
AU - Crijns, Harry J. G. M.
AU - Freedman, Ben
AU - Hills, Mellanie True
AU - Healey, Jeff S.
AU - Kamel, Hooman
AU - Kim, Dong-Yun
AU - Link, Mark S.
AU - Lopes, Renato D.
AU - Lubitz, Steven A.
AU - McManus, David D.
AU - Noseworthy, Peter A.
AU - Perez, Marco
AU - Piccini, Jonathan P.
AU - Schnabel, Renate B.
AU - Singer, Daniel E.
AU - Tieleman, Robert G.
AU - Turakhia, Mintu P.
AU - Van Gelder, Isabelle C.
AU - Cooper, Lawton S.
AU - Al-Khatib, Sana M.
N1 - Funding Information: Dr Benjamin is an uncompensated member of the MyHeartLab Steering Committee, which is a principal investigator–initiated (Jeffrey Olgin, MD) research grant to University of California, San Francisco 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 (A Study to Determine if Identification of Undiagnosed Atrial Fibrillation in People at Least 70 Years of Age Reduces the Risk of Stroke; 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 electrocardiographic monitors) from Roche Diagnostics and iRhythm. Dr Crijns receives unrestricted grant support from Medtronic Trading NL BV. Dr Freedman reports grants to the institution, personal fees, and nonfinancial 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 BV. Dr Healy reports research grants and speaking fees from Medtronic, Boston Scientific, Abbott, BMS/Pfizer, Servier, Cipher Pharma, and ARCA Biopharm. Dr Healy also is supported by the Stuart Connolly Chair in Cardiology Research, McMaster University. Dr Kamel serves as co–principal investigator for the NIH-funded ARCADIA trial (Antithrombotic Drugs in Prevention After Cryptogenic Stroke), 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 end point 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 Funding Information: 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; has consulted for Bristol Myers Squibb/Pfizer and Bayer AG; and participates in a research collaboration with IBM. Dr McManus has received research support from Bristol Myers Squibb, Care Evolution, Samsung, Apple Computer, Pfizer, Biotronik, Boehringer Ingelheim, Philips Research Institute, FLEXcon, and Fitbit and has consulted for Bristol Myers Squibb, Pfizer, Philips, Samsung Electronics, Fitbit, Rose Consulting, Boston Biomedical Associates, and FLEXcon. Dr McMa-nus is also a member of the Operations Committee and Steering Committee for the GUARD-AF Study (NCT04126486) sponsored by Bristol Meyers Squibb and Pfizer and 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 and steering committee/advisory board/consulting for Boehringer Ingelheim, Bristol-My-ers Squibb, Fitbit, Johnson & 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, and grants from St. Jude Medical. In addition, Dr Tieleman has a patent as a coinventor of the MyDiagnostick issued. Dr Turakhia reports grants from Bristol Myers Squibb, Apple, Janssen, Boehringer-Ingelheim, American Heart Association, Medtronic, and Bayer; consulting fees from Medtronic, Myokardia, Biotronik, Pfizer, and Johnson & Johnson; and 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. Dr Al-Khatib reports consulting fees from Milestone Pharmaceuticals; research, speaking, and consulting fees from Medtronic; research and speaking fees from Abbott; and speaking fees from Bristol-Myers Squibb/Pfizer. Funding Information: Dr Benjamin receives research funding from US NIH, NHLBI grants R01HL128914, 2R01HL092577, R01HL141434 01A1, NIH National Institute of Aging grant R01AG066010, and American Heart Association 18SFRN34110082. Dr Go receives research funding from the US NIH, NHLBI grant R01HL142834, and National Institute of Diabetes and Digestive and Kidney Diseases R01DK103612. Dr Anderson receives research funding from NIH National Institute of Neurological Disorders and Stroke R01NS103924 and American Heart Association 18SFRN34250007. Dr Casadei is supported by program grants from the British Heart Foundation and by the National Institute for Health Research Oxford Biomedical Research Center. Dr Chen receives research funding from US NIH, NHLBI R01HL126637, and R01HL141288 and additional support from R01HL142599 and R01HL127659. Dr Crijns receives 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, Electric 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, Electric Remodeling, and Vascular Destabilisation in the Progression of AF (RACE V). Dr Kamel receives research funding from NIH NHLBI R01HL144541 and National Institute of Neurological Disorders and Stroke R01NS097443. Dr Lubitz receives research funding from NHLBI grant R01HL139731 and American Heart Association 18SFRN34250007. Dr McMa-nus receives support from US NIH, NHLBI grants R01HL126911, R01HL137734, R01HL137794, R01HL135219, R01HL136660, and U54HL143541. Dr Perez receives support from US NIH, NHLBI grant R01HL136390. Dr Piccini’s time is supported by R01HL128595 from the NHLBI. Dr Schnabel receives funding from the European Union’s Horizon 2020 Research and Innovation Program under grant agreement 847770 AFFECT-EU, the European Research Council under the European Union’s Horizon 2020 Research and Innovation Program (grant agreement 648131), 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. Publisher Copyright: © 2021 Lippincott Williams and Wilkins. All rights reserved.
PY - 2021/1/26
Y1 - 2021/1/26
N2 - Clinically recognized atrial fibrillation (AF) is associated with higher risk of complications, including ischemic stroke, cognitive decline, heart failure, myocardial infarction, and death. It is increasingly recognized that AF frequently is undetected until complications such as stroke or heart failure occur. Hence, the public and clinicians have an intense interest in detecting AF earlier. However, the most appropriate strategies to detect undiagnosed AF (sometimes referred to as subclinical AF) and the prognostic and therapeutic implications of AF detected by screening are uncertain. Our report summarizes the National Heart, Lung, and Blood Institute's virtual workshop 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. Our report aims to inform and catalyze AF screening research that will advance innovative, resource-efficient, and clinically relevant studies in diverse populations to improve the diagnosis, management, and prognosis of patients with undiagnosed AF.
AB - Clinically recognized atrial fibrillation (AF) is associated with higher risk of complications, including ischemic stroke, cognitive decline, heart failure, myocardial infarction, and death. It is increasingly recognized that AF frequently is undetected until complications such as stroke or heart failure occur. Hence, the public and clinicians have an intense interest in detecting AF earlier. However, the most appropriate strategies to detect undiagnosed AF (sometimes referred to as subclinical AF) and the prognostic and therapeutic implications of AF detected by screening are uncertain. Our report summarizes the National Heart, Lung, and Blood Institute's virtual workshop 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. Our report aims to inform and catalyze AF screening research that will advance innovative, resource-efficient, and clinically relevant studies in diverse populations to improve the diagnosis, management, and prognosis of patients with undiagnosed AF.
KW - AUSTRALIAN CLINICAL GUIDELINES
KW - CARDIAC SOCIETY
KW - COMPREHENSIVE EVALUATION
KW - CRYPTOGENIC STROKE
KW - EHRA CONSENSUS DOCUMENT
KW - ORAL ANTICOAGULANTS
KW - PRIMARY-CARE
KW - RHYTHM MONITORING STRATEGIES
KW - SOCIEDAD LATINOAMERICANA
KW - TRANSIENT ISCHEMIC ATTACK
KW - atrial fibrillation
KW - diagnostic screening programs
KW - prevention and control
KW - research
KW - stroke
U2 - 10.1161/circulationaha.120.047633
DO - 10.1161/circulationaha.120.047633
M3 - Article
C2 - 33493033
SN - 0009-7322
VL - 143
SP - 372
EP - 388
JO - Circulation
JF - Circulation
IS - 4
ER -