Recent-onset atrial fibrillation: challenges and opportunities

Atrial fibrillation (AF) is increasingly diagnosed early, close to its first occurrence due to: (i) increased public awareness with self-screening; (ii) health care initiatives including population screening and opportunistic case finding; and (iii) increased use and surveillance of implantable cardiac devices. At its onset, AF is often low burden, and cardiovascular co-morbidities may be absent or at an early stage. Thus, the management of recent-onset AF has become an issue of growing importance. Professional guidelines have traditionally focused on anticoagulant thromboprophylaxis, generally recommending a cautious approach to rhythm control, and priority has been given to rate control to alleviate symptoms. In recent guidelines, the importance of managing lifestyle and co-morbidities has increased. The AF-SCREEN collaboration proposes that a vigorous approach to active management of recent-onset AF may be warranted. This includes addressing co-morbidities and promoting healthy lifestyles to prevent the emergence or progression of AF and associated cardiovascular disease, as well as the initiation of active rhythm control ± anticoagulation to prevent AF-related morbidity and mortality, including stroke and heart failure (HF). Intuitively, intervention early after AF onset would be beneficial since lifestyle and co-morbidity management, plus rhythm control and anticoagulation, are important contributors to improved outcomes in patients with established AF, but robust evidence is lacking for recent-onset AF. There is a delicate balance between achieving favourable outcomes such as preventing strokes, HF and AF progression vs the complications and potential adverse effects of interventions. Given the serious long-term consequences, innovative approaches are necessary to determine the value and risks of initiating active therapy very early in the course of AF. More data are needed to guide the best management of recent-onset AF, bearing AF burden in mind. Long-term studies using large national databases linked to electronic medical records and rhythm monitoring devices offer excellent opportunities. Shorter-term studies focusing on reducing AF burden to slow AF progression and studies focusing on outcomes such as HF could be used in both randomized clinical trials and observational cohort studies.

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Publication Details

Journal
European Heart Journal
Published
2025-06-23
DOI
https://doi.org/10.1093/eurheartj/ehaf478
Citations
9
Primary Topic
Atrial Fibrillation Management and Outcomes
Type
article
Field-Weighted Citation Impact
12.49

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article

Recent-onset atrial fibrillation: challenges and opportunities

Yutao Guo, Ben Freedman, Karl Georg Hæusler, Linda Johnson et al.
9 citations
European Heart Journal
Atrial Fibrillation Management and Outcomes
12.49
article

Recent-onset atrial fibrillation: challenges and opportunities

Yutao Guo, Ben Freedman, Karl Georg Hæusler, Linda Johnson, Richard Hobbs, Jeff S. Healey, Søren Zöga Diederichsen, Deirdre A. Lane, A. John Camm, Luciano Alberto Sposato, Konstantinos C. Siontis, Jeroen Hendriks, Sakis Themistoclakis, Helena Domínguez, ROD S. PASSMAN, Gerhard Hindricks, Jessica Joan Orchard, Josep Lluís Clua‐Espuny, Mellanie True Hills, Daniel D. Reidpath, Léna Rivard, Gregory Y.H. Lip, Georges H. Mairesse, Prashanthan Sanders, Moti Haim, Peter A. Noseworthy, Axel Brandes, Paulus Kirchhof, Laurent Fauchier, Yitschak Biton, Boyoung Joung, Lars‐Åke Levin, Steven R. Steinhubl, Gregory M. Marcus, James A. Reiffel, Alan C. Cameron, Trudie Lobban, Robert G Tieleman, Jesper Hastrup Svendsen, Hooman Kamel, Claire Mary Buckley, Roopinder K. Sandhu, Matteo Anselmino, Taya V. Glotzer, A. Teh, George Ntaios, Stavros Stavrakis, David Duncker, Wolfram Doehner, Jason G. Andrade, Peter W. Macfarlane, Renate B. Schnabel, Shaowen Liu, Harry J.G.M. Crijns, Emma Svennberg, Antônio Luiz Pinho Ribeiro, Giuseppe Boriani
article en
9 citations

Abstract

Atrial fibrillation (AF) is increasingly diagnosed early, close to its first occurrence due to: (i) increased public awareness with self-screening; (ii) health care initiatives including population screening and opportunistic case finding; and (iii) increased use and surveillance of implantable cardiac devices. At its onset, AF is often low burden, and cardiovascular co-morbidities may be absent or at an early stage. Thus, the management of recent-onset AF has become an issue of growing importance. Professional guidelines have traditionally focused on anticoagulant thromboprophylaxis, generally recommending a cautious approach to rhythm control, and priority has been given to rate control to alleviate symptoms. In recent guidelines, the importance of managing lifestyle and co-morbidities has increased. The AF-SCREEN collaboration proposes that a vigorous approach to active management of recent-onset AF may be warranted. This includes addressing co-morbidities and promoting healthy lifestyles to prevent the emergence or progression of AF and associated cardiovascular disease, as well as the initiation of active rhythm control ± anticoagulation to prevent AF-related morbidity and mortality, including stroke and heart failure (HF). Intuitively, intervention early after AF onset would be beneficial since lifestyle and co-morbidity management, plus rhythm control and anticoagulation, are important contributors to improved outcomes in patients with established AF, but robust evidence is lacking for recent-onset AF. There is a delicate balance between achieving favourable outcomes such as preventing strokes, HF and AF progression vs the complications and potential adverse effects of interventions. Given the serious long-term consequences, innovative approaches are necessary to determine the value and risks of initiating active therapy very early in the course of AF. More data are needed to guide the best management of recent-onset AF, bearing AF burden in mind. Long-term studies using large national databases linked to electronic medical records and rhythm monitoring devices offer excellent opportunities. Shorter-term studies focusing on reducing AF burden to slow AF progression and studies focusing on outcomes such as HF could be used in both randomized clinical trials and observational cohort studies.

European Heart JournalVol. 47(2)
Linköping University (SE), Université de Tours (FR), Northwestern University (US), University of Modena and Reggio Emilia (IT), University of Copenhagen (DK), Ben-Gurion University of the Negev (IL), Western University (CA), The University of Sydney (AU), Concord Hospital (US), Hackensack University Medical Center (US), University Medical Center Groningen (NL), Karolinska University Hospital (SE), Box Hill Hospital (AU), University of Liverpool (GB), Universität Hamburg (DE), St George's, University of London (GB), University of Calgary (CA), University of Groningen (NL), University of Southern Denmark (DK), University of California, San Francisco (US), Queen Margaret University (GB), Shanghai Jiao Tong University (CN), Lund University (SE), Yonsei University (KR), Hebrew University of Jerusalem (IL), Cornell University (US), Purdue University West Lafayette (US), University College Cork (IE), American Society for Reproductive Medicine (US), Hadassah Medical Center (IL), Severance Hospital (KR), Maastricht University Medical Centre (NL), Concord Repatriation General Hospital (AU), Montreal Heart Institute (CA), Austin Hospital (AU), Glasgow Royal Infirmary (GB), AHEPA University Hospital (GR), Frederiksberg Hospital (DK), The Heart Research Institute (AU), Oxford Health NHS Foundation Trust (GB), Copenhagen University Hospital (DK), Shanghai Chest Hospital (CN), Vancouver General Hospital (CA), Population Health Research Institute (CA), Chinese PLA General Hospital (CN), Queen Margaret Hospital (GB), Maastricht University (NL), Medizinische Hochschule Hannover (DE), Health Service Executive (IE), Liverpool Heart and Chest Hospital (GB), Azienda Ospedaliera Citta' della Salute e della Scienza di Torino (IT), MIND Research Institute (US), Eastern Health (AU), Deutsches Herzzentrum der Charité (DE), University Medical Center Hamburg-Eppendorf (DE), Azienda Ospedaliero-Universitaria di Modena (IT), Martini Ziekenhuis (NL), Department of Health (TW), Region of Southern Denmark (DK), Health Foundation (GB), Mayo Clinic in Arizona (US), Berlin-Brandenburger Centrum für Regenerative Therapien (DE), German Centre for Cardiovascular Research (DE), Institut Universitari d'Investigació en Atenció Primària Jordi Gol (ES), Hospital das Clínicas da Universidade Federal de Minas Gerais (BR), Hospital South West Jutland (DK), Stratford Hospital (GB), Berlin Institute of Health at Charité - Universitätsmedizin Berlin (DE), Department of Health Services (NP), Gangnam Severance Hospital (KR), Ospedale dell' Angelo (IT), Cliniques du Sud Luxembourg (BE), Hackensack Meridian Health (US), Hospital Universitari de Tortosa Verge de la Cinta (ES), University Hospital Ulm (DE), Weill Cornell Medicine (US), City St George's, University of London (GB), University of Oklahoma Health Sciences Center (US), University of Turin (IT), Libin Cardiovascular Institute of Alberta (CA), The University of Adelaide (AU), Université de Montréal (CA), Columbia University (US), Charité - Universitätsmedizin Berlin (DE), University of Glasgow (GB), University of Birmingham (GB), Aalborg University (DK), McMaster University (CA)
American Heart Association, Bristol-Myers Squibb, Pfizer, Heart and Stroke Foundation of Canada, Patient-Centered Outcomes Research Institute, Hjerteforeningen, Deutsches Zentrum für Herz-Kreislaufforschung, NHS Greater Glasgow and Clyde, Innovationsfonden, Royal College of Physicians and Surgeons of Glasgow, Australian Government, An Roinn Sláinte, British Heart Foundation, Heart Research UK, Stroke Association, Chief Scientist Office, Tenovus, European Commission, University of Glasgow, Deutsche Forschungsgemeinschaft, Fondation Leducq, Flinders University, Bundesministerium für Bildung und Forschung, Conselho Nacional de Desenvolvimento Científico e Tecnológico, Svenska Sällskapet för Medicinsk Forskning, Hjärt-Lungfonden, Stockholms Läns Landsting, Vetenskapsrådet, Fundação de Amparo à Pesquisa do Estado de Minas Gerais, Deutsche Herzstiftung, Medical Research Council Canada, Utbildningsdepartementet, Stockholm läns landsting, Danmarks Frie Forskningsfond, Mason Medical Research Trust, National Institutes of Health, Bristol-Myers Squibb Canada, HORIZON EUROPE Framework Programme, Canadian Institutes of Health Research, Medical Research Council, European Research Council, National Health and Medical Research Council, Center for Innovative Medicine, National Institute on Alcohol Abuse and Alcoholism, National Heart, Lung, and Blood Institute, Interreg
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Atrial Fibrillation Management and Outcomes
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