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Study finds risk factors and biomarkers to more easily screen for atrial fibrillation

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Researchers have found two biomarkers they say could be used in primary care to identify the heart condition atrial fibrillation in patients who have three clinical risk factors.

Atrial fibrillation is the most common heart rhythm disturbance, affecting around 1.6 million people in the UK, noted the researchers from the University of Birmingham.

“The biomarkers we have identified have the potential to be used in a blood test in community settings”

Yanish Purmah

Those with atrial fibrillation may be aware of noticeable heart palpitations, when their heart feels like it is pounding, fluttering or beating irregularly, but sometimes it does not cause any symptoms.

Now the Birmingham scientists say they have identified patients are more at risk of atrial fibrillation if they have three “clinical risks” – namely being older, male and having a high body mass index.

These patients, say the scientists, could be screened to see if they have elevated levels of two biomarkers – a hormone secreted by the heart called brain natriuretic peptide (BNP) and a protein responsible for phosphate regulation called fibroblast growth factor-23 (FGF-23).

The study, published today in European Heart Journal, analysed 40 common cardiovascular biomarkers in a cohort of 638 hospital patients.

“It is important that patients at risk are screened so that they can begin taking anticoagulants”

Winnie Chua

To obtain the results, the scientists combined traditional statistical analysis with completely new and innovative machine learning techniques.

First author Dr Winnie Chua said: “It is important that patients at risk are screened so that they can begin taking anticoagulants to prevent potentially life-threatening complications.”

Joint first author Yanish Purmah noted that an electrocardiogram (ECG) was usually used to screen patients for atrial fibrillation.

“ECG screening is resource-intensive and burdensome for patients, therefore, it is important that the right patients are selected for this type of screening,” he said.

“The biomarkers we have identified have the potential to be used in a blood test in community settings such as in GP practices to simplify patient selection for ECG screening,” he added.

Senior author Dr Larissa Fabritz highlighted that the research outcomes “were surprising”. “While BNP is already a known and widely used in clinical practice biomarker, the results around the effectiveness of the FGF-23 biomarker was an unexpected and new finding,” she said.

“The study may pave the way towards better detection of people with AF and their targeted treatment”

Metin Avkiran

Professor Metin Avkiran, associate medical director at the British Heart Foundation, added: “This research has used sophisticated statistical and machine learning methods to analyse patient data and provides encouraging evidence that a combination of easy-to-measure indices may be used to predict atrial fibrillation.

“The study may pave the way towards better detection of people with AF and their targeted treatment with blood-thinning medicines for the prevention of stroke and its devastating consequences,” he added.

The research, which began in 2013, is ongoing and next steps will involve follow-ups of the patients recruited to the study in order to further improve the prevention and treatment of atrial fibrillation.

The research was supported by CATCH ME, an EU-funded consortium led by the University of Birmingham, the British Heart Foundation and Leducq Foundation.

It was carried out in collaboration with Sandwell and West Birmingham Hospitals NHS Trust, University Hospitals Birmingham NHS Foundation Trust, the European Society of Cardiology, The German Atrial Fibrillation NETwork, and Health Data Research UK.

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