"Want to reduce the risk of strokes by 20 per cent"

Cardiac arrhythmias after a stroke are particularly dangerous, as they can easily trigger another attack. Atrial fibrillation increases the risk of stroke fivefold. In order to prevent new strokes by improving the diagnosis of cardiac arrhythmias, scientists from Leipzig, Mainz and Göttingen are investigating more than 5,000 patients who have recently suffered a stroke in one of the largest clinical studies in Germany. Prof Dr Rolf Wachter, Professor of Clinical and Interventional Cardiology at the University of Leipzig and Deputy Clinic Director of Cardiology at Leipzig University Hospital, is leading the study. In the interview, the expert also explains the causes of atrial fibrillation.

Professor Wachter, your current research project on atrial fibrillation is being supported by the German Research Foundation for a further three years and now with a total of 13.8 million euros. This makes it currently the most DFG-funded clinical study in Germany. Why is the topic so relevant for the population?

„No disease of the cardiovascular system is as feared by people as a stroke. The main reason is probably that life afterwards is often completely different from before and people can be very limited in their physical functions or permanently dependent on the help of others. We know that a quarter of strokes are caused by atrial fibrillation. In these patients, blood clots form in the left atrium of the heart. The risk can be reduced by around two-thirds through blood thinning, known as anticoagulation.

Why then are there still many strokes in patients with atrial fibrillation, even though we know how they can be prevented?

„The disease atrial fibrillation is often tückish. It does not occur permanently, but only from time to time. It can therefore happen that a patient has an electrocardiogram (ECG) that shows no atrial fibrillation, and yet this person can have atrial fibrillation for a few hours, a few days or even a few months before or after this.“

You have been researching this topic for 15 years and have been conducting the aforementioned large clinical stroke study for four years. How exactly does this work?

„The study is called Find-AF 2, Finding Atrial Fibrillation in Stroke Patients 2. A total of 5,200 patients who have suffered a stroke within the last 30 days will take part in this study. Half of the patients will receive prolonged, improved and intensified cardiac rhythm monitoring, while the other half will receive the current standard care. Heart rhythm monitoring is carried out both with long-term ECG devices, which, however, are applied for more than one week and at least once a year, and with small implantable event recorders that permanently record the heart rhythm. Despite the coronavirus pandemic, over three quarters of the patients needed have been found at 51 study centres throughout Germany within three years. If atrial fibrillation is found through these measures, those affected are almost always prescribed blood thinners after a stroke. We believe that this intensified search will enable us to find atrial fibrillation so early in many patients that we will be able to prevent around one in five new strokes.

What insights do you hope to gain at the end of this large-scale, nationwide research project?

„We will probably have found all 5,200 patients in the spring of next year. The participants in the study will then be followed up for another two years. In the second half of 2026, we will know whether our approach is able to reduce the risk of recurrent strokes in Germany by 20 per cent.

Press release of the "Leipzig University Hospital" from 22 August 2023