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

Elizabeth Paratz1, Xinying Zhou2, Caio A M Tavares3,4

  • 1St Vincent's Institute for Medical Research, Melbourne, Australia.

Global Heart
|June 1, 2026
PubMed

Insights

Clinical guidelines lack recommendations for screening atrial fibrillation (AF) in patients with rheumatic heart disease (RHD), despite AF being a common complication. Only one policy document explicitly recommended AF screening for RHD patients, highlighting a significant gap.

Area of Science:

  • Cardiology
  • Public Health Policy

Background:

  • Rheumatic heart disease (RHD) and atrial fibrillation (AF) represent significant global health challenges.
  • Atrial fibrillation affects up to one-third of individuals with RHD, yet current clinical guidelines lack specific recommendations for AF screening in this high-risk population.

Purpose of the Study:

  • To identify and review existing guidelines and policies concerning AF and RHD.
  • To assess whether current recommendations include AF screening for patients diagnosed with RHD.
  • To identify any existing policy gaps in AF screening for RHD patients.

Main Methods:

  • A narrative policy content review was conducted, encompassing guidelines, consensus statements, position statements, and policy documents related to AF or RHD.
  • Documents were identified through comprehensive searches in MEDLINE, national/international cardiovascular society websites, and citation tracking.
  • A narrative synthesis approach was employed for content review.

Main Results:

  • A total of 29 relevant documents were identified: 16 focused on AF and 13 on RHD.
  • While 13 AF-focused documents recommended screening in general high-risk populations, only the 2021 Asia Pacific Heart Rhythm Society (APHRS) guidance explicitly recommended AF screening for RHD patients.
  • None of the 13 RHD-focused documents specifically recommended AF screening, despite acknowledging AF as a frequent complication.

Conclusions:

  • A significant gap exists in current guidelines and policies regarding AF screening for individuals with RHD.
  • Only one identified policy document provided specific recommendations for AF screening in RHD patients.
  • Further research is necessary to develop tailored AF screening guidelines for RHD populations across diverse settings.
Abstract

Keywords:
advocacyatrial fibrillationpreventionrheumatic heart diseasescreening

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