No abstract

No abstract

No abstract

The HFA Atlas survey was conducted in 2018-2019 in 42 ESC countries. The quality and completeness of source data varied across countries. The median incidence of HF was 3.20 [interquartile range (IQR) 2.66-4.17] cases per 1000 person-years, ranging from ≤2 in Italy and Denmark to >6 in Germany. The median HF prevalence was 17.20 (IQR 14.30-21) cases per 1000 people, ranging from ≤12 in Greece and Spain to >30 in Lithuania and Germany. The median number of HF hospitalizations was 2671 (IQR 1771-4317) per million people annually, ranging from <1000 in Latvia and North Macedonia to >6000 in Romania, Germany and Norway. The median length of hospital stay for an admission with HF was 8.50 (IQR 7.38-10) days. Diagnostic and management resources for HF varied, with high-income ESC member countries having substantially more resources compared with middle-income countries. The median number of hospitals with dedicated HF centres was 1.16 (IQR 0.51-2.97) per million people, ranging from <0.10 in Russian Federation and Ukraine to >7 in Norway and Italy. Nearly all countries reported full or partial reimbursement of standard GDMT, except ivabradine and sacubitril/valsartan. Almost all countries reported having NHFS or working groups and nearly half had HF patient organizations.

At least 30 million people worldwide carry a diagnosis of atrial fibrillation (AF), and many more suffer from undiagnosed, subclinical, or 'silent' AF. Atrial fibrillation-related cardiovascular mortality and morbidity, including cardiovascular deaths, heart failure, stroke, and hospitalizations, remain unacceptably high, even when evidence-based therapies such as anticoagulation and rate control are used. Furthermore, it is still necessary to define how best to prevent AF, largely due to a lack of clinical measures that would allow identification of treatable causes of AF in any given patient. Hence, there are important unmet clinical and research needs in the evaluation and management of AF patients. The ensuing needs and opportunities for improving the quality of AF care were discussed during the fifth Atrial Fibrillation Network/European Heart Rhythm Association consensus conference in Nice, France, on 22 and 23 January 2015. Here, we report the outcome of this conference, with a focus on (i) learning from our 'neighbours' to improve AF care, (ii) patient-centred approaches to AF management, (iii) structured care of AF patients, (iv) improving the quality of AF treatment, and (v) personalization of AF management. This report ends with a list of priorities for research in AF patients.

COVID-19 is also manifested with hypercoagulability, pulmonary intravascular coagulation, microangiopathy, and venous thromboembolism (VTE) or arterial thrombosis. Predisposing risk factors to severe COVID-19 are male sex, underlying cardiovascular disease, or cardiovascular risk factors including noncontrolled diabetes mellitus or arterial hypertension, obesity, and advanced age. The VAS-European Independent Foundation in Angiology/Vascular Medicine draws attention to patients with vascular disease (VD) and presents an integral strategy for the management of patients with VD or cardiovascular risk factors (VD-CVR) and COVID-19. VAS recommends (1) a COVID-19-oriented primary health care network for patients with VD-CVR for identification of patients with VD-CVR in the community and patients' education for disease symptoms, use of eHealth technology, adherence to the antithrombotic and vascular regulating treatments, and (2) close medical follow-up for efficacious control of VD progression and prompt application of physical and social distancing measures in case of new epidemic waves. For patients with VD-CVR who receive home treatment for COVID-19, VAS recommends assessment for (1) disease worsening risk and prioritized hospitalization of those at high risk and (2) VTE risk assessment and thromboprophylaxis with rivaroxaban, betrixaban, or low-molecular-weight heparin (LMWH) for those at high risk. For hospitalized patients with VD-CVR and COVID-19, VAS recommends (1) routine thromboprophylaxis with weight-adjusted intermediate doses of LMWH (unless contraindication); (2) LMWH as the drug of choice over unfractionated heparin or direct oral anticoagulants for the treatment of VTE or hypercoagulability; (3) careful evaluation of the risk for disease worsening and prompt application of targeted antiviral or convalescence treatments; (4) monitoring of D-dimer for optimization of the antithrombotic treatment; and (5) evaluation of the risk of VTE before hospital discharge using the IMPROVE-D-dimer score and prolonged post-discharge thromboprophylaxis with rivaroxaban, betrixaban, or LMWH.

Ассоциации ESC: Европейская ассоциация по профилактике и реабили-тации сердечно-сосудистых заболеваний (EACPR), Европейская ассоциа-ция сердечно-сосудистой визуализации (EACVI), Европейская ассоциация сердечного ритма (EHRA), Ассоциация по сердечной недостаточности (HFA).Советы ESC: Совет по сестринскому уходу за больными с сердечно-сосудис тыми заболеваниями и смежным специальностям, Совет по кардио-логической практике, Совет по первичному оказанию помощи больным с сердечно-сосудистыми заболеваниями, Совет специалистов по артери-альной гипертензии. Рабочие группы ESC:Клеточная электрофизиология сердца, Фармакотера-пия сердечно-сосудистых заболеваний, Врожденные пороки сердца у взрос-лых, Тромбоз, Клапанная болезнь сердца.Содержание данных рекомендаций, подготовленных Европейским общест вом кардиологов (European Society of Cardiology, ESC, опубликовано исключи-тельно для использования в личных и образовательных целях. Не допуска ется коммерческое использование содержания рекомендаций. Рекомендации ESC не могут быть переведены на другие языки либо воспроизведены, полно стью или частично, без письменного согласия ESC. Для получения данного согласия письменная заявка должна быть направлена в Oxford University Press -органи-зацию, издающую European Heart Journal и официально упол номоченную ESC, рассматривать подобные заявки.Отказ от ответственности. Рекомендации ESC отражают взгляды ESC и основаны на тщательном анализе научных данных, доступных во время подготовки данных рекомендаций. ESC не несет ответственности в случае противоречий, расхождений и/или неоднозначных моментов между дан-ными рекомендациями и любыми другими официальными рекомендаци-ями или руководствами, изданными действующими организациями здра-воохранения, в особенности в отношении правильного использования стратегий медицинского обслуживания и лечения. Медицинским работни-кам следует придер живаться данных рекомендаций в процессе принятия клинических решений. В то же время, рекомендации не могут заменить личную ответственность медицинских работников при принятии клиниче-ских решений с учетом индивидуальных особенностей и предпочтений пациентов и, при необходимости, предпочтений их опекунов и попечите-лей. Медицинские работники также несут ответственность в отношении дополнительной проверки всех надлежа щих требований и правил перед назначением лекарственных средств и использованием медицинского оборудования. Ключевые слова: клинические рекомендации, фибрилляция предсердий, антикоагулянтный эффект, антагонисты витамина К, пероральные антикоагу-лянты, не являющиеся антагонистами витамина К, окклюзия ушка левого предсердия, контроль частоты сердечных сокращений, кардиоверсия, конт-роль ритма, антиаритмические препараты, upstream терапия, катетерная аблация, хирургическое лечение фибрилляции предсердий, хирургические вмешательства на клапанах сердца, изоляция устьев легочных вен, аблация левого предсердия.

There are major challenges ahead for clinicians treating patients with atrial fibrillation (AF). The population with AF is expected to expand considerably and yet, apart from anticoagulation, therapies used in AF have not been shown to consistently impact on mortality or reduce adverse cardiovascular events. New approaches to AF management, including the use of novel technologies and structured, integrated care, have the potential to enhance clinical phenotyping or result in better treatment selection and stratified therapy. Here, we report the outcomes of the 6th Consensus Conference of the Atrial Fibrillation Network (AFNET) and the European Heart Rhythm Association (EHRA), held at the European Society of Cardiology Heart House in Sophia Antipolis, France, 17-19 January 2017. Sixty-two global specialists in AF and 13 industry partners met to develop innovative solutions based on new approaches to screening and diagnosis, enhancing integration of AF care, developing clinical pathways for treating complex patients, improving stroke prevention strategies, and better patient selection for heart rate and rhythm control. Ultimately, these approaches can lead to better outcomes for patients with AF.