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Integrated care of patients with atrial fibrillation: the 2016 ESC atrial fibrillation guidelines
  1. Paulus Kirchhof1,2,3,4
  1. 1Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
  2. 2Sandwell and West Birmingham Hospitals NHS Trust and University Hospitals Birmingham Foundation NHS trust, Birmingham, UK
  3. 3Department of Cardiovascular Medicine, University Hospital Muenster, Germany
  4. 4Atrial Fibrillation NETwork, Muenster, Germany
  1. Correspondence to Professor Paulus Kirchhof, Institute of Cardiovascular Sciences, University of Birmingham, Wolfson Drive, Birmingham, B15 2TT, UK; p.kirchhof{at}bham.ac.uk

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Atrial fibrillation (AF) is one of the evolving epidemics in cardiovascular medicine. AF is projected to develop in 25% of currently 40-year-old adults,1 ,2 provokes many, often severe strokes, is associated with increased mortality and often leads to heart failure or sudden death even in well-anticoagulated patients.3 ,4 The last few years have seen the development of new approaches to detect and treat patients with AF, from ECG screening to surgical procedures to prevent recurrent AF. While these improvements provide tools to improve outcomes and quality of life in affected patients, they often need multidisciplinary input into patient management. It therefore seems timely that the European Society of Cardiology (ESC) has issued new AF guidelines in August 2016.5

Good management of patients with AF requires a team effort

Reflecting the need for multidisciplinary input, the 2016 ESC AF guidelines task force consisted of cardiologists with different degrees of sub-specialisation, cardiac surgeons, a stroke neurologist and a specialist nurse, nominated by the ESC and its constituent bodies including the European Heart Rhythm Association, the European Association of Cardio-Thoracic Surgeons and the European Stroke Organization. All recommendations were discussed and voted upon in a predefined process, accepting only recommendations supported by at least 75% of the Task Force members after a structured consultation. Thirty-three general reviewers reviewed the entire guideline in three iterations, while 49 additional reviewers nominated by the ESC National Societies focusing on the class I and III recommendations provided further valuable comments.5

Screening for AF

ECG screening can help detect asymptomatic AF, allowing timely initiation of therapy, especially oral anticoagulation. This has the potential to prevent complications of AF, especially ischaemic strokes. The ESC guidelines recommend opportunistic ECG screening whenever a person aged 65 years or older is seen by a healthcare professional.6 In addition, and beyond prior guidelines, systematic ECG monitoring for at least 72 hours …

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