Heart Rhythm and Stroke Prevention

Our mission is to prevent strokes through early detection of silent atrial fibrillation (AF) and implement appropriate guideline-based management.

With a clinical implementation focus we are exploring novel strategies using eHealth tools and patient self-screening to detect unknown silent AF. AF is the most common abnormal heart rhythm – it is estimated that individuals over the age of 40 have a one in three lifetime risk of developing AF. AF is associated with one third of all strokes, which are largely preventable by anticoagulant medications that stop clots from forming inside the heart. Unfortunately, AF is frequently silent, especially in older people who are at greater risk of stroke, with the first sign of AF being a severe stroke.

Our AF screening research extends through collaborations with primary care and specialist clinics in Australia, the USA, Shanghai, Hong Kong, Japan, Vietnam, Germany and the UK.

Another major interest of our Group is to determine whether our Indigenous population has a higher burden of AF by screening in remote and rural Australia, in collaboration with the Poche Centre and the University of Auckland, NZ.

Our main activities are to determine how best to screen for AF at scale, and to prevent as many strokes as possible. The more people screened and treated, the more strokes we can prevent. We continue global advocacy for screening for AF through the AF-SCREEN International Collaboration and the World Heart Federation (WHF). This is likely to change guidelines and influence future government policy, and have a global impact on stroke reduction through the Leadership of the WHF Roadmap update on AF by Prof Freedman.

In fact, the Australian Heart Foundation and Cardiac Society of Australia and New Zealand 2018 guideline on the management of AF had opportunistic screening for unknown AF as its first recommendation, with a practice point being about use of a handheld ECG pioneered by our Group, quoting our Group’s work in its recommendation. Many of our papers on screening were also cited in the 2020 European Society of Cardiology AF guidelines.

If screening for AF could be implemented widely in those aged 65 or older, and this could be coupled with greater prescription of anticoagulant therapy as advised in guidelines, then thousands of strokes could be avoided, not only in Australia but globally.

Freedman B, et al. Screening for atrial fibrillation: a report of the AF-SCREEN International Collaboration (white paper) Circulation 2017; 135: 1851-67.

Lowres N, et al. Estimated stroke risk, yield, and number needed to screen for atrial fibrillation detected through single time screening: a multicountry patient-level meta-analysis of 141,220 screened individuals. PLOS Medicine 2019;16:e1002903.

Lowres N, et al. Feasibility and cost effectiveness of stroke prevention through community screening for atrial fibrillation using iPhone ECG in pharmacies. The SEARCH-AF study. Thromb Haemost 2014; 111: 1167-76.

Freedman B, et al. Asymptomatic atrial fibrillation. The case for screening to prevent stroke. JAMA 2015; 314: 1911-12.

Freedman B, et al. Stroke prevention in atrial fibrillation. Lancet 2016; 388: 806-17.

Orchard J, et al. Atrial fibrillation: is there enough evidence to recommend opportunistic or systematic screening? Int J Epidemiol 2018; 47:1372-78.

Orchard J, et al. eHealth Tools to Provide Structured Assistance for Atrial Fibrillation Screening, Management, and Guideline-Recommended Therapy in Metropolitan General Practice: The AF-SMART Study. J Am Heart Assoc 2019; Jan 8; (1): e010959. doi: 10.1161/JAHA.118.010959.