The European Society of Cardiology (ESC) today announces the launch of EHRA-PATHS, an EU-funded project to improve the management of elderly atrial fibrillation patients with multiple conditions. The announcement comes during EHRA 2021, the online annual congress of the European Heart Rhythm Association (EHRA) of the ESC.

More than 40 million individuals worldwide have atrial fibrillation, which is the most common heart rhythm disorder. Risk of developing the disorder rises with age and the number of other conditions including high blood pressure, diabetes, heart failure, coronary artery disease, kidney disease, obesity, and obstructive sleep apnoea. Patients with atrial fibrillation have an average of five co-existing conditions and these comorbidities have a negative impact on survival. In addition, three-quarters of atrial fibrillation patients take at least five drugs.

Scientific coordinator Professor Hein Heidbuchel, EHRA’s Immediate Past-President, said: “Atrial fibrillation is a warning sign that patients may have other disorders, which is why they take numerous medications. This presents huge challenges for making sure that all conditions are addressed, and patients receive well-tailored therapy.”

EHRA-PATHS is the first multicentre EU-wide project on integrated care for elderly patients with atrial fibrillation and at least one additional chronic condition. EHRA is coordinating the programme, also a first, which involves cardiology and other specialties such as endocrinology and nephrology in each hospital, another novelty. “We will create a management tool to help physicians take a systematic approach to patients with atrial fibrillation which ensures that all comorbidities are identified and attended to,” said Professor Heidbuchel.

The first phase of the project involves mapping multimorbidity and polypharmacy in elderly patients with atrial fibrillation across Europe, including an analysis of potential differences between women and men. The second phase is to discover whether co-existing conditions are currently handled in clinical practice and identify gaps in management. In the third phase, a new overall care pathway will be developed as a software tool.

Phase four is a clinical study in 45 hospitals across 11 EU countries. In each hospital, cardiology plus one other specialty will participate. New atrial fibrillation patients seen during a six-month period will be re-evaluated six months later to see if co-existing conditions were addressed or not – to establish a baseline picture. Centres will then be randomly allocated to the software tool or usual care to see whether the novel management strategy results in more comorbidities receiving appropriate attention. A cost-effectiveness analysis will be included.

Professor Heidbuchel noted that each centre will customise the tool to local referral practices. He said: “To take one example, the tool will not dictate how obese patients must be managed. But it will remind physicians that the issue needs to be dealt with, with a localised pathway adapted to their hospital’s protocols, local availabilities and patient preferences.” EHRA-PATHS is not an outcome trial but wants to guarantee that evidenced-based therapies reach the patient.

He concluded: “As a result of this project, we hope the presentation of atrial fibrillation will be taken as an opportunity by the medical community to methodically address comorbidities. This should lead to better management of individual patients, less polypharmacy, and improved adherence to effective therapies.”