Atrial Fibrillation Screening in Those with Rheumatic Heart Disease: A Narrative Policy Content Review

Background: Rheumatic heart disease (RHD) and atrial fibrillation (AF) are major global health burdens. AF affects up to one-third of individuals with RHD, yet clinical guidelines lack recommendations for AF screening in this population.

Aim: To identify and review current guidelines/policies for AF and RHD to assess whether recommendations are made for AF screening in patients with RHD, thereby identifying any policy gaps.

Methods: A narrative policy content review was conducted. This included: guidelines, consensus statements, position statements and policy documents regarding AF or RHD. Documents were identified through searches in MEDLINE, national/international cardiovascular society websites and citation tracking. A narrative synthesis approach was used to review content.

Results: A total of 29 documents were identified (16 focussed on AF; 13 on RHD). Of the 16 AF-focussed documents, 13 recommended AF screening in the general population in high-risk groups, based on age and comorbidities. Only one, the 2021 Asia Pacific Heart Rhythm Society (APHRS) AF practice guidance, explicitly recommended AF screening in higher-risk patients with RHD. The 13 RHD-focussed documents acknowledged AF as a frequent complication, particularly in advanced valvular disease, but none specifically recommended screening.

Conclusion: This review highlights a clear gap in current guidelines and policies for AF screening in those with RHD. Although AF is a common complication of RHD, only one policy document was identified that provided specific recommendations for AF screening in patients with RHD. Further work is needed to inform and develop appropriate AF screening guidelines tailored to RHD populations in different settings.