Insights and new tools towards better integrated atrial fibrillation care: Comorbidity management, patient awareness, and the role of cardiac rehabilitation

Abstract

Atrial fibrillation (AF) is the most common arrhythmia, affecting 1-3% of adults in Europe. People aged 55 or older have a 37% chance of developing AF, and it is predicted that the prevalence of AF will increase in the upcoming decades. Guidelines emphasise the importance of integrated care and structured management for AF. In recent years, this has led to the development of the AF-CARE approach, which is recommended for use by healthcare providers (HCP). The optimal AF treatment (i.e. the AF-CARE approach) focuses on: (C) Comorbidity and risk factor management, (A) Avoid stroke and thromboembolism, (R) Reduce symptoms by rate and rhythm control, (E) Evaluation and dynamic reassessment. Multimorbidity is common in patients with AF, which refers to the presence of two or more chronic conditions. Older patients (≥65y) typically have an average of four additional comorbidities on top of their AF. Managing comorbidities is the primary focus of the 2024 European Society of Cardiology guidelines for AF management. This PhD thesis aimed to develop systematic, integrated care pathways to tackle multimorbidity in patients with AF. This thesis consists of two main aspects: 1) Integrated AF care through the EHRA-PATHS project, and 2) Evaluating the impact of cardiac rehabilitation on AF recurrences after AF ablation by pulmonary vein isolation (PVI).