Atrial Fibrillation (AF) Burden and Stroke Risk

The KP-RHYTHM Study

Alan S. Go, MD; Kristi Reynolds, PhD, MPH; Jingrong Yang, MA; Nigel Gupta, MD; Judith Lenane, RN, MHA; Sue Hee Sung, MPH; Teresa N. Harrison, SM; Taylor I. Liu, MD, PhD; Matthew D. Solomon, MD, PhD

Managing atrial fibrillation (AF) patients’ risk for stroke is challenging. Clinical assessment guidelines currently view atrial fibrillation as a binary entity, determining the need to initiate anticoagulation based on whether or not AF is present and the patient’s risk profile. However, a recently published study, KP-RHYTHM, suggests that a new measure for assessing stroke risk in patients with paroxysmal atrial fibrillation (PAF) may exist, calling to attention: should we be rethinking how we assess and manage our PAF patients?

As published in JAMA Cardiology

Key Findings

Results

Of the 1965 patients evaluated, the median AF burden was 4.4% (1.1% to 17.2%)
An AF burden of 11.4 percent or higher was associated with more than three-fold increased risk for stroke or TE event after adjusting for either CHA₂DS₂-VASc or ATRIA scores
Consistent findings across key demographics and subgroups with similar strength of association in patients without prior stroke
Stronger association in those without any exposure to anticoagulants
No association with longest AF episode

Standardizing AF Burden Monitoring

The challenge of collecting reliable AF burden data with intermittent monitoring is that we can only account for brief periods of AF measurement such as daily burden — which can fluctuate greatly. The KP-RHYTHM results were achieved by using a noninvasive, continuous monitor that could capture up to 14 days of uninterrupted data.

"Using a 24-hour monitoring window, patients with a single 24-hour episode over the span of 1 year will have the same AF burden as patients with sustained AF over the span of 1 year, although they would likely have different prognoses."¹

— AHA Scientific Statement 2018

Study Links a Precise AF Burden Threshold to Higher Stroke Risk

The KP-RHYTHM Study

Key Findings

Study Design

Results

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Additional Resources

Read the Full AHA Scientific Statement

Learn more about the monitor used for KP-RHYTHM