Research priorities in the secondary prevention of atrial fibrillation: A national heart, lung, and blood institute virtual workshop report

Emelia J. Benjamin, Sana M. Al-Khatib, Patrice Desvigne-Nickens, Alvaro Alonso, Luc Djoussé, Daniel E. Forman, Anne M. Gillis, Jeroen M.L. Hendriks, Mellanie True Hills, Paulus Kirchhof, Mark S. Link, Gregory M. Marcus, Reena Mehra, Katherine T. Murray, Ratika Parkash, Ileana L. Piña, Susan Redline, Michiel Rienstra, Prashanthan Sanders, Virend K. SomersDavid R. Van Wagoner, Paul J. Wang, Lawton S. Cooper, Alan S. Go

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)

Abstract

There has been sustained focus on the secondary prevention of coronary heart disease and heart failure; yet, apart from stroke prevention, the evidence base for the secondary prevention of atrial fibrillation (AF) recurrence, AF progression, and AF-related complications is modest. Although there are multiple observational studies, there are few large, robust, randomized trials providing definitive effective approaches for the secondary prevention of AF. Given the increasing incidence and prevalence of AF nationally and internationally, the AF field needs transformative research and a commitment to evidenced-based secondary prevention strategies. We report on a National Heart, Lung, and Blood Institute virtual workshop directed at identifying knowledge gaps and research opportunities in the secondary prevention of AF. Once AF has been detected, lifestyle changes and novel models of care delivery may contribute to the prevention of AF recurrence, AF progression, and AF-related complications. Although benefits seen in small subgroups, cohort studies, and selected randomized trials are impressive, the widespread effectiveness of AF secondary prevention strategies remains unknown, calling for development of scalable interventions suitable for diverse populations and for identification of subpopulations who may particularly benefit from intensive management. We identified critical research questions for 6 topics relevant to the secondary prevention of AF: (1) weight loss; (2) alcohol intake, smoking cessation, and diet; (3) cardiac rehabilitation; (4) approaches to sleep disorders; (5) integrated, team-based care; and (6) nonanticoagulant pharmacotherapy. Our goal is to stimulate innovative research that will accelerate the generation of the evidence to effectively pursue the secondary prevention of AF.

Original languageEnglish
Article numbere021566
Number of pages33
JournalJournal of the American Heart Association
Volume10
Issue number16
DOIs
Publication statusPublished - 17 Aug 2021

Keywords

  • Atrial fibrillation
  • Cardiac rehabilitation
  • Prevention
  • Research
  • Risk factors
  • Sleep

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