Optimizing prognosis in atrial fibrillation: A call to action in Portugal
Jorge Ferreira a); Natália António b),c); Nuno Cortez-Dias d); Luciana Ricca Gonçalves e); João Sargento-Freitas c),f); Pedro von Hafe g),h); Victor Gil i),j)
a) Serviço de Cardiologia, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Portugal
b) Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
c) Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal
d) Serviço de Cardiologia, Departamento de Coração e Vasos, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
e) Serviço de Imuno-hemoterapia, Centro Hospitalar Universitário São João, Porto, Portugal
f) Serviço de Neurologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
g) Serviço de Medicina Interna, Centro Hospitalar de S. João, Porto, Portugal
h) Departamento de Medicina da Faculdade de Medicina da Universidade do Porto, Porto, Portugal
i) Unidade Cardiovascular, Hospital Lusíadas Lisboa, Lisboa, Portugal
j) Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
Abstract
Atrial fibrillation (AF), the most common arrhythmia in the adult population worldwide, represents a significant burden in terms of cardiovascular mortality and morbidity and has repercussions on health economics. Oral anticoagulation (OAC) is key to stroke prevention in AF and, in recent years, results from landmark clinical trials of non-vitamin K oral anticoagulants (NOAC) have triggered a paradigm shift in thrombocardiology. Despite these advances, there is still a significant residual vascular risk associated with silent AF, bleeding, premature sudden death and heart failure.
The authors review AF epidemiologic data, the importance of new tools for early AF detection, the current role of catheter ablation for rhythm control in AF, the state-of-the-art in periprocedural OAC, the optimal management of major bleeding, the causes of residual premature death and future strategies for improvements in AF prognosis.