Figure 1
Despite the significant overlap of AF and RHD, only one guideline advocated for routine screening to occur. *Estimated AF numbers are likely inaccurate due to non-identification in people living with RHD – in systematically examined RHD populations, prevalence is up to 1 in 3, which would already create an estimate of up to 100 million cases globally.
AF, atrial fibrillation; RHD, rheumatic heart disease.
Figure 2
Flowchart of document identification and review process.
Table 1
Key characteristics of included AF-focussed guidelines, policies and documents.
| TITLE AND TYPE | DOCUMENT, YEAR | LMIC OR HIC SETTING? | ORGANISATION(S) | MENTIONS RHD? | INCLUDES RECOMMENDATIONS? | |
|---|---|---|---|---|---|---|
| AF SCREENING | AF SCREENING IN THOSE WITH RHD | |||||
| 1. 2012 RCPE UK Expert consensus | Stott et al., 2012 (22) | HIC | Royal College of Physicians of Edinburgh (RCPE), UK | Yes | Yes | No |
| 2. 2015 HIQA Health Technology Assessment | HIQA, 2015 (23) | HIC | Health Information and Quality Authority, Ireland | No | Yes | No |
| 3. 2015 Brazilian Guidelines for AF | Magalhaes et al., 2016 (24) | LMIC | Brazilian Society of Cardiology | No | No | No |
| 4. 2016 EPCCS Consensus guidance | Hobbs et al., 2016 (25) | HIC | European Primary Care Cardiovascular Society (RPCCS) | Yes | Yes | No |
| 5. 2017 EHRA Expert consensus | Mairesse et al., 2017 (26) | HIC | European Heart Rhythm Association (EHRA), endorsed by Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE). | No | Yes | No |
| 6. 2017 AF-SCREEN Expert consensus | Freedman et al., 2017 (7) | n/a – INT | AF-SCREEN International Collaboration | Yes | Yes | No |
| 7. 2018 Aus/NZ Guideline | Brieger et al., 2018 (17) | HIC | National Heart Foundation of Australia & Cardiac Society of Australia and New Zealand (CSANZ) | Yes | Yes | No |
| 8. 2018 Korean Guideline | Joung et al., 2018 (27) | HIC | Korean Heart Rhythm Society (KHRS) | No | Yes | No |
| 9. 2020 WHF Roadmap | Freedman et al., 2021 (28) | n/a – INT | World Heart Federation (WHF) | Yes | Yes | No |
| 10. 2020 CCS/CHRS Guideline | Andrade et al., 2020 (29) | HIC | Canadian Cardiovascular Society/Canadian Heart Rhythm Society | Yes | Yes | No |
| 11. 2021 APHRS Practice guidance | Chan et al., 2021 (15) | n/a – INT | Asia Pacific Heart Rhythm Society | Yes | Yes | Yes |
| 12. 2021 NICE Guideline | NICE, 2021 (20) | HIC | National Institute for Health and Care Excellence (NICE), UK | No | Yes | No |
| 13. 2022 USPSTF Recommendation statement | Davidson et al., 2022 (30) | HIC | US Preventive Services Task Force (USPSTF) | No | No | No |
| 14. 2023 ACC/AHA/ACCP/HRS Guideline | Joglar et al., 2023 (21) | HIC | American College of Cardiology (ACC), American Heart Association (AHA), American College of Chest Physicians (ACCP), Heart Rhythm Society (HRS) | Yes | No | No |
| 15. 2024 Chinese Guideline | Ma et al., 2024 (31) | LMIC | Chinese Society of Cardiology (CSC), Chinese Medical Doctor Association (CMDA) | No | Yes | No |
| 16. 2024 ESC Guideline | Van Gelder et al., 2024 (11) | HIC | European Society of Cardiology (ESC) | Yes | Yes | No |
[i] HIC, high-income country; LMIC, low- and middle-income country; n/a – INT, not applicable – international paper.
Table 2
Key characteristics of included RHD-focussed guidelines.
| TITLE & TYPE | DOCUMENT, YEAR | LMIC OR HIC SETTING? | EVALUATION OF AF RISK IN RHD | RECOMMENDATIONS ON AF SCREENING IN RHD |
|---|---|---|---|---|
| 1. 2003 Western Cape Guideline | Western Cape Government, South Africa, 2003 (37) | HIC | No | No |
| 2. 2012 Kimberley RHD Guideline | Kimberley Aboriginal Medical Services Council & WA Country Health Service, Australia, 2012 (40) | HIC | Yes | No |
| 3. 2015 India handbook | Ministry of Health and Family Welfare, India, 2015 (38) | LMIC | No | No |
| 4. 2018 National Guidelines for Public Health Units | Communicable Diseases Network, Australia, 2018 (41) | HIC | Yes | No |
| 5. 2017 Fiji Guideline | Ministry of Health and Medical Services, Fiji, 2017 (33) | HIC | Yes | No |
| 6. 2018 Kenya Guideline | Ministry of Health, Kenya, 2018 (34) | LMIC | Yes | No |
| 7. 2018 WHO Report | WHO, 2018 (39) | n/a – INT | No | No |
| 8. 2020 AHA Scientific Statement | Kumar et al., 2020 (42) | HIC | Yes | No |
| 9. 2020 JCS/JSCS/JATS/JSVS Valvular Heart Disease Guideline | Izumi et al., 2020 (43) | HIC | Yes | No |
| 10. 2024 WHO Guideline | WHO, 2024 (2) | n/a – INT | Yes | No |
| 11. 2024 New Zealand Guideline | Health New Zealand, 2024 (32) | HIC | Yes | No |
| 12. 2024 Sudan Guideline | Sulafa et al., 2024 (35) | LMIC | Yes | No |
| 13. 2025 Australian Guideline | RHD Australia, 2025 (36) | HIC | Yes | No |
[i] AHA, American Heart Association; HIC, high-income country; NSW, New South Wales; JCS, Japanese Circulation Society; JSCS, Japanese Society of Cardiac Surgery; JATS, Japanese Association for Thoracic Surgery; JSVS, Japanese Society for Vascular Surgery; LMIC, low- and middle-income country; n/a – INT, not applicable – international paper; RHD, rheumatic heart disease; WHO, World Health Organisation; WA, Western Australia.