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Atrial fibrillation (AF) constitutes an increasing challenge to the medical community and healthcare providers. With a prevalence of almost 3% in the adult Swedish population1 and a forecasted twofold or threefold increase by 2050 in the USA, we are facing a diagnosis with epidemic proportions.
Apart from increased mortality, AF also increases the risk of heart failure, hospitalisations and ischaemic stroke.2 Of these complications, ischaemic stroke gives a particularly heavy burden on patients, their family and society. Ischaemic stroke is the most common reason for permanent neurological disability in the adult Western population, and stroke in connection to AF and cardiac emboli results in worse neurological outcome and higher mortality in relation to other subtypes of stroke.3
In patients with AF and stroke risk factors, oral anticoagulation (OAC) therapy reduces the risk of ischaemic stroke and systemic emboli by 60–70%. Unfortunately, there is still widespread undertreatment with OAC in patients with AF and risk factors.
AF is often present with no or very subtle symptoms, both in paroxysmal form and in permanent form. The absence of symptoms reduces the chance of recognition and diagnosis, in particular in paroxysmal cases, since patients will not seek medical attention for their arrhythmia. The prevalence of so-called silent AF is only partly known since yield in screening studies varies with ECG recording duration. There are, however, no data supporting that silent AF have better outcomes in comparison with AF with typical presentation.4 …
Contributors ES and JE contributed equally to this manuscript.
Competing interests ES has received lecture fees from MSD, Bristol-Myers Squibb-Pfizer, Boehringer-Ingelheim and Sanofi and a research grant from Boehringer-Ingelheim. JE has received consultancy fees from Sanofi and Pfizer, lecture fees from Astra Zeneca, Boehringer-Ingelheim, Medtronic and Bristol-Myers Squibb and travel expenses from Boehringer-Ingelheim and Sanofi.
Provenance and peer review Commissioned; internally peer reviewed.