{
  "release_id": "5dcd9b263fe17744",
  "id": "cardio:bottleneck-undiagnosed-af",
  "owner": "cardio",
  "kind": "bottleneck",
  "slug": "bottleneck-undiagnosed-af",
  "name": "AF that causes no symptoms is hard to diagnose",
  "aliases": [],
  "atlases": [
    "cardio"
  ],
  "summary_plain": "Some people with atrial fibrillation feel nothing, and the National Heart, Lung, and Blood Institute says this makes the condition difficult to diagnose. The same institute names stroke and heart failure among the serious problems that untreated atrial fibrillation can cause. Checking the pulse outside the clinic, for example with a smartwatch, is one way people are trying to find it.",
  "summary_technical": "The burden statement rests on the NHLBI atrial fibrillation page, which gives no number for how many people have symptomless atrial fibrillation or how long it goes unnoticed. This atlas does not claim that it goes unrecognized until a stroke, because no source read says so. A large smartwatch-alert study looked at alerts as one way to detect it. In that study 34% of notified participants who returned an analyzable ECG patch had atrial fibrillation on it, so an alert is a prompt to get checked and not a diagnosis.",
  "editorial_state": "draft",
  "last_substantive_edit": "2026-10-15",
  "last_evidence_check": "2026-10-14",
  "next_review_due": null,
  "identifiers": [],
  "navigation": {
    "cardio": {
      "condition-area": [
        "arrhythmias",
        "stroke"
      ]
    }
  },
  "payload": {
    "stage": "Detection and diagnosis, before a person knows they have atrial fibrillation",
    "scope": "Adults with atrial fibrillation who have no symptoms, as the NHLBI page describes in general terms.",
    "severity_rationale": "NHLBI links untreated atrial fibrillation to serious, even life-threatening, problems and names stroke and heart failure.",
    "burden_claims": [
      "cardio:claim-af-can-be-silent"
    ],
    "current_efforts": [
      "cardio:wearable-rhythm-detection"
    ]
  },
  "content_digest": "851481c632ea0607e4c0a5df059dc571d1a54c74394ea22129334577f66f894e",
  "review": {
    "content_digest": "851481c632ea0607e4c0a5df059dc571d1a54c74394ea22129334577f66f894e",
    "current": [],
    "conflicting": [],
    "stale": [],
    "inactive": []
  },
  "claims": [
    {
      "release_id": "5dcd9b263fe17744",
      "id": "cardio:claim-af-can-be-silent",
      "owner": "cardio",
      "subject_entity_id": "cardio:bottleneck-undiagnosed-af",
      "category": "burden",
      "statement": "NHLBI notes that atrial fibrillation may cause no symptoms at all, which can be difficult to diagnose. It also says untreated atrial fibrillation can have serious, even life-threatening, consequences, and it names stroke and heart failure. The page gives no figure for how many people have atrial fibrillation without symptoms or how long it goes undiagnosed.",
      "context": {
        "id": "cardio:ctx-nhlbi-adults-with-atrial-fibrillation",
        "label": "Adults with atrial fibrillation, in general terms (NHLBI and MedlinePlus patient pages)",
        "recipient": "adult",
        "population": "People with atrial fibrillation, described in general terms. NHLBI puts the number of US adults with atrial fibrillation above 2 million and says the chance of developing it grows with age. The pages do not describe a study population.",
        "care_setting": "Not applicable (patient information pages, not a study)",
        "geography": "Not stated in the pages for most statements; the prevalence sentence refers to the United States",
        "life_stage_note": "Adults in general. NHLBI describes atrial fibrillation as uncommon in children.",
        "life_stage_terms": null,
        "gestational_age_min_days": null,
        "gestational_age_max_days": null,
        "gestational_age_basis": null,
        "postnatal_age_min_days": null,
        "postnatal_age_max_days": null,
        "gestational_age_status": null,
        "postnatal_age_status": null,
        "followup_description": "Not applicable (patient information pages)",
        "eligibility": {
          "inclusion": [],
          "exclusion": []
        }
      },
      "evidence_stage": "synthesis",
      "certainty": "not_assessed",
      "certainty_method": null,
      "limitations": "One patient information page. It gives no count of people with symptomless atrial fibrillation and no time to diagnosis, and it does not say that diagnosis comes only after a stroke.",
      "editorial_state": "draft",
      "checked_at": "2026-10-14",
      "next_review_due": null,
      "valid_from": null,
      "valid_to": null,
      "citations": [
        {
          "evidence_role": "supports",
          "locator": "Page body, paragraph 2",
          "applicability_note": "Atrial fibrillation can occur without symptoms and be hard to diagnose.",
          "snapshot": {
            "id": "cardio:nhlbi-atrial-fibrillation-2026-10-14",
            "retrieved_at": "2026-10-14T18:19:49Z",
            "content_hash": "b64d9b1406c4b990086b6d55055c216af16abf1f9606593924807e1d6f07c0d9",
            "source_effective_date": null,
            "public_archive_url": null,
            "source_state": "current"
          },
          "source": {
            "id": "cardio:nhlbi-atrial-fibrillation",
            "source_type": "webpage",
            "title": "Atrial Fibrillation: What Is Atrial Fibrillation? (NHLBI)",
            "canonical_url": "https://www.nhlbi.nih.gov/health/atrial-fibrillation",
            "identifiers": [],
            "publication_date": null,
            "publisher": "National Heart, Lung, and Blood Institute (NIH)",
            "edition": "Page as fetched on 2026-10-14, with the line Last updated on November 30, 2022.",
            "reuse_basis": "Page of the NHLBI website, fetched as cf-nhlbi-atrial-fibrillation.html. Only the hash is kept. The NHLBI terms pages tried returned HTTP 404 (cf-nhlbi-website-policies.html, cf-nhlbi-copyright.html), the NIH web-policies pages returned HTTP 403 (cf-nih-web-policies-notices.html, cf-nih-copyright.html), and the NHLBI privacy and accessibility page (cf-nhlbi-website-privacy-accessibility.html) states no copyright terms. The arrhythmia page also credits a copyrighted animation. The reuse terms are therefore unverified, so public text is cite_only: facts are stated in this atlas's own words.",
            "public_text": "cite_only"
          }
        },
        {
          "evidence_role": "supports",
          "locator": "Page body, paragraph 2 (passage 2)",
          "applicability_note": "Complications of untreated atrial fibrillation.",
          "snapshot": {
            "id": "cardio:nhlbi-atrial-fibrillation-2026-10-14",
            "retrieved_at": "2026-10-14T18:19:49Z",
            "content_hash": "b64d9b1406c4b990086b6d55055c216af16abf1f9606593924807e1d6f07c0d9",
            "source_effective_date": null,
            "public_archive_url": null,
            "source_state": "current"
          },
          "source": {
            "id": "cardio:nhlbi-atrial-fibrillation",
            "source_type": "webpage",
            "title": "Atrial Fibrillation: What Is Atrial Fibrillation? (NHLBI)",
            "canonical_url": "https://www.nhlbi.nih.gov/health/atrial-fibrillation",
            "identifiers": [],
            "publication_date": null,
            "publisher": "National Heart, Lung, and Blood Institute (NIH)",
            "edition": "Page as fetched on 2026-10-14, with the line Last updated on November 30, 2022.",
            "reuse_basis": "Page of the NHLBI website, fetched as cf-nhlbi-atrial-fibrillation.html. Only the hash is kept. The NHLBI terms pages tried returned HTTP 404 (cf-nhlbi-website-policies.html, cf-nhlbi-copyright.html), the NIH web-policies pages returned HTTP 403 (cf-nih-web-policies-notices.html, cf-nih-copyright.html), and the NHLBI privacy and accessibility page (cf-nhlbi-website-privacy-accessibility.html) states no copyright terms. The arrhythmia page also credits a copyrighted animation. The reuse terms are therefore unverified, so public text is cite_only: facts are stated in this atlas's own words.",
            "public_text": "cite_only"
          }
        }
      ],
      "review": {
        "content_digest": "d491be126f901267d86aae42dc57cdcf79b50f7e158372ac1b95f5f91993dc0c",
        "current": [],
        "conflicting": [],
        "stale": [],
        "inactive": []
      },
      "api_path": "api/v1/claims/cardio--claim-af-can-be-silent.json"
    }
  ],
  "decisions": [],
  "milestones": [],
  "relationships": {
    "outgoing": [
      {
        "predicate": "related_to",
        "label": "The condition that can be silent",
        "clinical_claim_not_fact": false,
        "family": "navigation",
        "other_entity_id": "cardio:atrial-fibrillation",
        "other_entity_in_atlas": true,
        "claim_id": null,
        "evidence": null,
        "primary": false,
        "role": null,
        "valid_from": null,
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      },
      {
        "predicate": "part_of",
        "label": "Filed under this front",
        "clinical_claim_not_fact": false,
        "family": "navigation",
        "other_entity_id": "cardio:front-devices-and-monitoring",
        "other_entity_in_atlas": true,
        "claim_id": null,
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    "incoming": [
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        "predicate": "addresses",
        "label": "Addressed by",
        "clinical_claim_not_fact": false,
        "family": "navigation",
        "other_entity_id": "cardio:idea-wearable-af-screening",
        "other_entity_in_atlas": true,
        "claim_id": null,
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      {
        "predicate": "addresses",
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        "clinical_claim_not_fact": false,
        "family": "navigation",
        "other_entity_id": "cardio:wearable-rhythm-detection",
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        "claim_id": null,
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  },
  "page_path": "bottlenecks/bottleneck-undiagnosed-af/",
  "context_path": "api/v1/context/cardio--bottleneck-undiagnosed-af.md"
}