World Heart Federation Roadmap on Atrial Fibrillation - A 2020 Update.

The World Heart Federation (WHF) commenced a Roadmap initiative in 2015 to reduce the global burden of cardiovascular disease and resultant burgeoning of healthcare costs. Roadmaps provide a blueprint for implementation of priority solutions for the principal cardiovascular diseases leading to death and disability. Atrial fibrillation (AF) is one of these conditions and is an increasing problem due to ageing of the world's population and an increase in cardiovascular risk factors that predispose to AF. The goal of the AF roadmap was to provide guidance on priority interventions that are feasible in multiple countries, and to identify roadblocks and potential strategies to overcome them. Since publication of the AF Roadmap in 2017, there have been many technological advances including devices and artificial intelligence for identification and prediction of unknown AF, better methods to achieve rhythm control, and widespread uptake of smartphones and apps that could facilitate new approaches to healthcare delivery and increasing community AF awareness. In addition, the World Health Organisation added the non-vitamin K antagonist oral anticoagulants (NOACs) to the Essential Medicines List, making it possible to increase advocacy for their widespread adoption as therapy to prevent stroke. These advances motivated the WHF to commission a 2020 AF Roadmap update. Three years after the original Roadmap publication, the identified barriers and solutions were judged still relevant, and progress has been slow. This 2020 Roadmap update reviews the significant changes since 2017 and identifies priority areas for achieving the goals of reducing death and disability related to AF, particularly targeted at low-middle income countries. These include advocacy to increase appreciation of the scope of the problem; plugging gaps in guideline management and prevention through physician education, increasing patient health literacy, and novel ways to increase access to integrated healthcare including mHealth and digital transformations; and greater emphasis on achieving practical solutions to national and regional entrenched barriers. Despite the advances reviewed in this update, the task will not be easy, but the health rewards of implementing solutions that are both innovative and practical will be great.

Patient associations as stakeholders: a valuable partner for facilitating access to therapy.

One set of important objectives of patient associations is to provide education, support, and advice to those affected by cardiac arrhythmias to ensure that they have access to appropriate diagnosis and treatment. In this perspective it is essential to establish a balanced partnership between patients and clinicians in order to facilitate the work of the patient association. Such associations must work under the guidance of and in consultation with a medical advisory committee for the production of appropriate and validated educational and awareness materials. Patient association coalitions represent and promote partnerships between professionals, patients, government, organizations, and industry. The power of an alliance works in bringing pressure to bear, in lobbying on behalf of specific patient groups. This type of coalition may also act as a depository for relevant databases and contact information relating to all the members who participate in the coalition, and facilitate rapid and complete communication between all interested parties. When fully developed it may also serve to provide current information on the diagnosis, treatment, and management of cardiac arrhythmias to patients, paramedical staff, and physicians. The Arrhythmia Alliance, initially established in the UK but now developing on an international basis sources, collates, and reflects views and data collected from members, bringing beneficial perspectives to the fore to ensure that change is led by the people and for the people.