Risk Factor Management and Atrial Fibrillation Clinics: Saving the Best for Last?

Rajiv Mahajan; Rajeev K Pathak; Anand Thiyagarajah; Dennis H Lau; Francis E Marchlinski; Sanjay Dixit; John D Day; Jeroen M L Hendriks; Melinda Carrington; Jonathan M Kalman; Prashanthan Sanders

doi:10.1016/j.hlc.2017.05.123

Risk Factor Management and Atrial Fibrillation Clinics: Saving the Best for Last?

Heart Lung Circ. 2017 Sep;26(9):990-997. doi: 10.1016/j.hlc.2017.05.123. Epub 2017 Jun 9.

Affiliations

¹ Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, SA, Australia.
² Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, SA, Australia; Cardiac Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
³ Cardiac Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
⁴ Intermountain Medical Center Heart Institute, Intermountain Medical Center, Murray, UT, USA.
⁵ Baker IDI, Melbourne, Vic, Australia.
⁶ Department of Cardiology, Royal Melbourne Hospital and the University of Melbourne, Melbourne, Vic, Australia.
⁷ Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, SA, Australia. Electronic address: prash.sanders@adelaide.edu.au.

PMID: 28662919
DOI: 10.1016/j.hlc.2017.05.123

Abstract

Atrial fibrillation (AF) is a leading cause of cardiovascular morbidity and mortality worldwide. Management of AF is a complex process involving: 1) the prevention of thromboembolic complications with anticoagulation; 2) rhythm control; and 3) the detection and treatment of underlying heart disease. However, cardiometabolic risk factors, such as obesity, hypertension, diabetes mellitus, and obstructive sleep apnoea, have been proposed as contributors to the expanding epidemic of atrial fibrillation (AF). Thus, a fourth pillar of AF care would include aggressive targeting of interdependent, modifiable cardiovascular risk factors as part of an integrated care model. Such risk factor management could retard and reverse the pathological processes underlying AF and reduce AF burden.

Keywords: Atrial fibrillation; Atrial remodelling; Cardiovascular risk factors.

Publication types

Review

MeSH terms

Atrial Fibrillation* / diagnosis
Atrial Fibrillation* / epidemiology
Atrial Fibrillation* / physiopathology
Global Health
Humans
Morbidity / trends
Risk Factors
Risk Management / methods*
Survival Rate / trends