Can you explain the rationale behind the AF screen International Collaboration Consortium?
Yes, this is named AF screen International Collaboration. Essentially a group of enthusiasts got together at last year’s ESC and formed a steering committee. Our aim was to promote the discussion, the study and the promulgation of screening for atrial fibrillation as a way to reduce stroke.
In that year, we’ve grown to 116 members from 31 countries. Members include, as well as cardiologists and electrophysiologists, general practitioners, general physicians, neurologists, stroke neurologists, pharmacists, health economists, statistitians and epidemiologists, nurses, physiotherapists, pharmacists. So the idea is that all of these people have a role to play in promotion of screening.
And importantly we include two representatives of patient organisations – the atrial fibrillation association and another one from the United States. Because patient input is very important and they are very strong advocates.
We have only just met to produce a consensus document, which is being drafted by about 60 of our members. We have voted on a number of consensus recommendations that we will put to the whole membership. And the idea is that we hope to have this published in the next few months in JAMA Cardiology – a new journal very interested in promoting organisations like us who don’t have any affiliations with any body and are truly an international organisation.
What is the remit of the AF Screen International Collaboration? Will you engage with existing international guideline providers?
The only continental guideline that really has any recommendation at all is the ESC guideline. And in the 2012 guideline there was only one recommendation for opportunistic screening during pulse taking. And that’s with pulse taking during practice followed by an ECG if irregular. That’s been increased this year, but every other guideline is silent on atrial fibrillation screening.
So one of our remits is, by promoting discussion, by having symposia on it, by publications, that things will change and the guidelines will start to recommend them.
We also need to look at what do the national screening societies need before they will recommend screening? In what ways can we do it? How will band together to get more information?
So there are a lot of things that we would like to do, but our very first task was to get a consensus document written – and we’re very close to that – and our next task is to get symposia at national meetings. And I’m very pleased to say that at the American Heart Association we have a joint symposium with the AHA precisely to talk about screening for atrial fibrillation to reduce stroke.
One of the things that people don’t realize is that one third of all ischaemic strokes are related to atrial fibrillation. And about 10 per cent of all ischaemic strokes, the atrial fibrillation is only first detected at the time of the stroke.
Now to us, of course if you go out looking at the population you find silent atrial fibrillation and high risk, it seems pretty logical that if you go out looking and treat it you will reduce stroke. So that’s really the rationale behind it.
But in the end we may need a big study that will require some collaboration across countries. And that’s why the international collaboration is important to produce the evidence that will strengthen the evidence base to allow us to recommend it more strongly.
But at the moment the ESC guideline that has just come out has strengthened its’ recommendations on screening and that’s a great start. We now need to see the same happening in America.
Where can cardiologists find out more information?
We do have a website – www.af-screen-intcollab.org – which has a bibliography of screening studies and we hope to populate it with what is ongoing with screening in atrial fibrillation. This is a work in progress.
It will also have on it all of the country-specific areas where we think something is happening, or we could do something. Anyone who is interested in this can look at the website and see what we’re up to.