John M. Mandrola


June 26, 2013

Anyone who cares for patients with atrial fibrillation knows that education is key. AF patients must understand and actively participate in the treatment of their disease. There's just no other way.

The European Heart Rhythm Association (EHRA) clearly agrees with this thesis. On the first day of EUROPACE 2013 , it has launched a new website for patients with atrial fibrillation. It's called, and first impressions are positive.

The site is easy to navigate, very easy on the eyes, and comprehensive. Simply said: it's all there.

Highlights include an early introduction to the CHA2DS2-VASc score. That's important because stroke prevention always comes first. Plus, on the front lines of care, misconceptions about anticoagulation are common.

The discussion of warfarin use was especially good. This section had a European flare. I was especially drawn to the emphasis of self-monitoring of INRs. We don't do enough of that in the US.

The description of catheter ablation was also quite good. The authors are clear about the chance of second and third ablation procedures, as well as the need for long-term anticoagulation after the procedure—another common misconception. (Patients with AF often present to me for ablation simply to get off anticoagulants.) A glaring weakness of the procedure discussion, however, was the lack of mention of risk. One doesn't want to scare patients who may benefit from the procedure, but if we talk percentages for stroke risk, why not talk about percentages with complications? Balancing the largeness of the procedure (risks) against its possible treasures (improved QoL) is always at the center of the decision to ablate AF.

The section on living with AF urges patients to get on with life. I loved that. The message is simple: eat well, drink fewer irritants (like alcohol), keep exercising, drive a car, travel, and even have sex. This is good; too many patients with AF bubble-wrap themselves. Opinion alert: perhaps excess worrying about the disease makes it worse?

A note on industry influence of the document: the European Heart Rhythm Association made it clear that site does not host any advertising of any sort. And "all funding support has been provided with no conditions, and at all times the EHRA retains complete governance and editorial control over" EHRA acknowledged that Bayer, Boehringer Ingelheim, and Daiichi-Sankyo contributed to this website with the support of unrestricted educational grants. What can one say about this other than to be practical: beautifully laid out, comprehensive websites don't come for free.

In short, the document does a nice job. Since we live in a global world, the expertise and "Euro" approach to AF is only a click away for all patients. As a practitioner on the front lines of treating AF, more education and less misconception are welcome.



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