The Future of atrial fibrillation management. Integrated care and stratified therapy

Atrial fibrillation is one of the major cardiovascular health problems: It is a common, chronic condition, affecting 2-3% of the populations in Europe and the USA and requiring 1-3% of health care expenditure due to stroke, sudden death, heart failure, unplanned hospitalizations, and other complications. Early diagnosis of AF, ideally before the first complication occurs, remains a challenge, illustrated by patients who are only diagnosed with AF when hospitalized for acute cardiac decompensation or stroke. Once diagnosed, AF requires chronic, multidimensional management in five domains (acute management, treatment of underlying and concomitant cardiovascular conditions, stroke prevention therapy, rate control, and rhythm control). Providing these treatment options consistently to all AF patients remains challenging, despite recent improvements. Integrated care models providing patient-centred care in or close to the community while maintaining access to all specialist treatment options emerge as the best approach to achieve consistent delivery of these chronic treatments to all AF patients in need of better management. Ongoing research efforts will determine when to initiate oral anticoagulation in patients with devicedetected atrial high rate episodes, quantify the prognostic impact of early and comprehensive rhythm control therapy including AF ablation, and delineate optimal methods to reduce bleeding complications in anticoagulated AF patients. In addition, research efforts are needed to define different types of AF based on the main causes of AF in a given patient to pave the way for the clinical development of stratified AF therapy.