Scientists at the University of Birmingham report the discovery of two biomarkers that could be used to identify atrial fibrillation in patients who have three clinical risks. Sometimes atrial fibrillation does not cause any symptoms and a person who has it is completely unaware that their heart rate is irregular.

Now scientists have identified patients are more at risk of atrial fibrillation if they are older, male, and have a high body mass index. These patients, the scientists said, could be screened for atrial fibrillation by testing their blood to see if they have elevated levels of two biomarkers—brain natriuretic peptide (BNP) and fibroblast growth factor-23 (FGF-23).

The study (“Data-driven discovery and validation of circulating blood-based biomarkers associated with prevalent atrial fibrillation”) was carried out by scientists from the Institute of Cardiovascular Sciences and the Institute of Cancer and Genomic Sciences at the University of Birmingham’s College of Medical and Dental Sciences and is published in European Heart Journal.

According to first author Winnie Chua, PhD, post-doctoral researcher at the Institute of Cardiovascular Sciences, “People with atrial fibrillation are much more likely to develop blood clots and suffer from strokes. To avoid strokes it is important for them to take anticoagulant drugs to prevent blood clotting. However, atrial fibrillation is often only diagnosed after a patient has suffered a stroke.

“Therefore it is important that patients at risk are screened so that they can begin taking anticoagulants to prevent potentially life-threatening complications.”

“An electrocardiogram (ECG), a test which measures the electrical activity of your heart to show whether or not it is working normally, is usually used to screen patients for atrial fibrillation,” added joint first author Yanish Purmah, MD. “ECG screening is resource-intensive and burdensome for patients, therefore, it is important that the right patients are selected for this type of screening. 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.”

Until now, most studies identifying biomarkers in patients with atrial fibrillation have been hypothesis-driven and involved the analysis of a single or small selection of blood biomarkers, noted the scientists, who analyzed 40 common cardiovascular biomarkers in a cohort of 638 hospital patients who were recruited between September 2014 and August 2016.

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

“The research outcomes were surprising,” said senior author Larissa Fabritz, MD, senior clinical lecturer in cardiovascular sciences, Institute of Cardiovascular Sciences. “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. FGF-23 is only currently used in a research-based environment, but we have shown how its use could be invaluable in a clinical setting.”

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