Question: Adequate implementation of European guidelines on stroke management in patients with atrial fibrillation
Atrial Fibrillation (AF) is the most commonly sustained heart rhythm abnormality. It is a major stroke risk factor affecting approximately 6 million people in Europe(1). That number is predicted to increase 2.5‑fold by 2050(2). Strokes that result from atrial fibrillation are the most severe. They are associated with high mortality and disability rates, and a 50 % likelihood of death within one year of having the stroke(3).
However, strokes can be prevented in patients with atrial fibrillation. Improving early diagnosis and the effective management of atrial fibrillation would reduce the risk of a European stroke epidemic. Furthermore, several sets of guidelines exist for the management of atrial fibrillation, including European guidelines from the European Society of Cardiology(4), but the degree to which they are properly implemented varies significantly from one Member State to another.
Can the Commission state:
1. How it can promote better awareness, earlier detection and improved management of atrial fibrillation, to prevent strokes in patients with atrial fibrillation?
2. In view of the existing European guidelines, what action does it propose taking to improve adherence to, and the implementation of, the existing European guidelines at national level?
(1) Kannel WB, Benjamin EJ: Status of the epidemiology of atrial fibrillation. Med Clin North Am 2008; 92:17–40.
(2) Go AS, Hylek EM, Phillips KA et al.: Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA 2001; 285:2370–5.
(3) Marini C, De Santis F, Sacco S et al. : Contribution of atrial fibrillation to incidence and outcome of ischemic stroke: results from a population based study. Stroke, 2005; 36:1115–19.
(4) European Society of Cardiology (ESC): Guidelines for the management of atrial fibrillation, European Heart Journal (2010) 31, 2369–2429.
Answer given by Mr Dalli on behalf of the Commission
The Commission is aware of the health risks associated with Atrial Fibrillation.
The focus of Commission action on Cardiovascular diseases is on prevention by developing initiatives to tackle smoking, nutrition, physical activity, and alcohol.
The Commission is working closely with the European Heart Network and the European Society for Cardiology, which has developed guidelines for the management of atrial fibrillation.
Moreover, the Commission has co-financed the ‘EuroHeart: European Heart Health Strategy project’, aimed at strengthening cooperation between healthcare professionals, NGOs, and public health authorities, and at supporting the implementation of the European Guidelines on the prevention of Cardiovascular diseases (CVD). As part of the project, the European Heart Health Charter was launched in the European Parliament in Brussels on July 2007; since then, the charter has been translated in 24 languages and endorsed in over 30 countries in Europe.
The project has identified differences and gaps in policies and actions across Europe, outlining the essential elements in a comprehensive national strategy on CVD; it has also provided an overview of action around cardiovascular health promotion and CVD prevention in 16 European countries. The project has highlighted that heart disease and stroke are the leading causes of death for women worldwide; and resulted in recommendations on women and CVD.
In addition, the 7th Framework Programme for Research and Technological Development (FP7) is supporting research in the areas of atrial fibrillation and stroke. The project EUTRAF(1), ‘the European Network for Translational Research in Atrial Fibrillation’, aims at improving the prevention, early diagnosis and therapy of this disease. The network gathers 16 institutions and is endowed with an EU financial contribution of EUR 12 million. Furthermore, EUR 21 million are being devoted to research on stroke and its prevention as part of the European Stroke Network(2).
The Commission does not currently have any plans to establish additional European guidelines.
(1) http://lib.bioinfo.pl/projects/view/21172
(2) http://www.europeanstrokenetwork.info/