• atrial fibrillation
• stroke

Because of the effectiveness of many interventions with drugs or devices in the primary prevention of cardiovascular events, there is great interest in developing accurate clinical prediction tools to determine in clinical practice who will benefit most from these interventions. This applies to lipid-lowering drugs reducing mortality in high-risk patients and prevention of sudden death using implantable cardioverter-defibrillators. By contrast, there is no such primary prevention strategy for the most common form of sustained arrhythmia, atrial fibrillation (AF).

AF is often underdetected and suboptimally managed, while it is a major cause of cardiovascular disease morbidity and mortality, by increasing the incidence of stroke, heart failure, dementia and hospitalisations with highly varying presentations in these events for each individual affected by AF. Regrettably, highly effective preventive therapies have not been identified to date for primary prevention of AF. Initially promising, a range of therapies has been found to be rather ineffective in preventing incident AF or AF recurrences, including statins, fish oil, angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers and various antiarrhythmic agents.1

However, given the multidimensional nature of AF, the concept of integrated care has been promoted to prevent AF incidence, AF recurrences and to improve patient outcomes, with some evidence of success. Integrated care includes stroke prevention and efforts to reduce cardiovascular risk factors as well as broader approaches that include nurse-led interventions, education and lifestyle changes (such as obesity management, exercise and healthy lifestyle efforts).2 Focusing efforts on increasing awareness among clinicians, patients and the general population helps to improve detection and a comprehensive or holistic approach might improve decision-making and approaches to management for patients at risk of AF.

In their Heart manuscript, Linker et al …