Atrial fibrillation and atrial flutter — DVA SoP factors

Reasonable Hypothesis (RH) — Statement of Principles No. 1 of 2023

At least one of the following factors must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting atrial fibrillation and atrial flutter or death from atrial fibrillation and atrial flutter with the circumstances of a person's relevant service:

1. (1)
   having valvular heart disease at the time of the clinical onset of atrial fibrillation or atrial flutter;

   Note: valvular heart disease is defined in the schedule 1 Dictionary.

2. (2)
   having ischaemic heart disease at the time of the clinical onset of atrial fibrillation or atrial flutter;
3. (3)
   having non-infectious myocarditis at the time of the clinical onset of atrial fibrillation or atrial flutter;

   Note: Non-infectious myocarditis can be acute or chronic.

   Note: Non-infectious myocarditis can be of autoimmune, infiltrative or immunological origin. Examples of causes of non-infectious myocarditis include immune checkpoint inhibitor therapy and giant cell myocarditis.

4. (4)
   having viral myocarditis at the time of the clinical onset of atrial fibrillation or atrial flutter;

   Note: Viral myocarditis can be acute or chronic.

   Note: Examples of viral causes of myocarditis include severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and dengue virus.

5. (5)
   having a non-viral infection of the myocardium at the time of the clinical onset of atrial fibrillation or atrial flutter;

   Note: Examples of causes of non-viral infection of the myocardium include Borrelia burgdorferi and leptospirosis.

6. (6)
   having pericarditis at the time of the clinical onset of atrial fibrillation or atrial flutter;
7. (7)
   having cardiomyopathy at the time of the clinical onset of atrial fibrillation or atrial flutter;
8. (8)
   having heart failure at the time of the clinical onset of atrial fibrillation or atrial flutter;
9. (9)
   having hypertension before the clinical onset of atrial fibrillation or atrial flutter;
10. (10)
    having pulmonary thromboembolism within the 30 days before the clinical onset of atrial fibrillation or atrial flutter;
11. (11)
    having a thyroid condition from the specified list of thyroid conditions at the time of the clinical onset of atrial fibrillation or atrial flutter;

    Note: specified list of thyroid conditions is defined in the Schedule 1 - Dictionary.

12. (12)
    consuming an average of at least 100 grams of alcohol per week for a continuous period of at least the 5 years before the clinical onset of atrial fibrillation or atrial flutter;

    Note: Alcohol consumption is calculated utilising the Australian Standard of 10 grams of alcohol per standard alcoholic drink.

13. (13)
    binge drinking within the 2 days before the clinical onset of atrial fibrillation or atrial flutter;

    Note: binge drinking is defined in the Schedule 1 - Dictionary.

14. (14)
    having a thoracic surgical procedure or an invasive cardiac procedure within the 1 year before the clinical onset of atrial fibrillation or atrial flutter; (a) coronary artery bypass grafting; (b) heart transplant; (c) open heart surgery; and (d) transcatheter aortic valve implantation;

    Note: Examples of thoracic surgical procedures include vascular, mediastinal, pulmonary and chest wall surgery.

    Note: Examples of invasive cardiac procedures include:.

15. (15)
    having a non-cardiothoracic surgical procedure involving general or regional anaesthesia, within the 30 days before the clinical onset of atrial fibrillation or atrial flutter;

    Note: Examples of non-cardiothoracic surgical procedures include emergency or elective orthopaedic and abdominal surgery and neurosurgery.

16. (16)
    having chronic obstructive pulmonary disease at the time of the clinical onset of atrial fibrillation or atrial flutter;
17. (17)
    having asthma of sufficient severity to require maintenance therapy at the time of the clinical onset of atrial fibrillation or atrial flutter;
18. (18)
    undertaking strenuous physical activity greater than 6 METs, for an average of at least 20 hours per week for a continuous period of at least the 5 years before the clinical onset of atrial fibrillation or atrial flutter;

    Note: MET is defined in the Schedule 1 - Dictionary.

19. (19)
    inability to undertake any physical activity greater than 3 METs for at least the 1 year before the clinical onset of atrial fibrillation and atrial flutter;

    Note: MET is defined in the Schedule 1 - Dictionary.

20. (20)
    having sick sinus syndrome at the time of the clinical onset of atrial fibrillation or atrial flutter;
21. (21)
    having a benign or malignant neoplasm involving the cardiac atrium at the time of the clinical onset of atrial fibrillation or atrial flutter;

    Note: A neoplasm involving the cardiac atrium can be primary or metastatic. An example of a primary neoplasm involving the heart is cardiac lymphoma.

22. (22)
    having a non-neoplastic lesion involving the cardiac atrium at the time of the clinical onset of atrial fibrillation or atrial flutter;

    Note: Examples of non-neoplastic lesions which can involve the cardiac atrium include cardiac tamponade and coronary artery aneurysm.

23. (23)
    having a malignant neoplasm, excluding non-melanotic malignant neoplasm of the skin, at the time of the clinical onset of atrial fibrillation or atrial flutter;
24. (24)
    undergoing a course of therapeutic radiation for cancer, where the heart was in the field of radiation, before the clinical onset of atrial fibrillation or atrial flutter;
25. (25)
    having diabetes mellitus for at least the 5 years before the clinical onset of atrial fibrillation or atrial flutter;
26. (26)
    experiencing penetrating trauma to the heart within the 1 year before the clinical onset of atrial fibrillation or atrial flutter;
27. (27)
    experiencing a blunt chest injury within the 7 days before the clinical onset of atrial fibrillation or atrial flutter;

    Note: blunt chest injury is defined in the Schedule 1 - Dictionary.

28. (28)
    having a spinal cord injury before the clinical onset of atrial fibrillation or atrial flutter;

    Note: spinal cord injury is defined in the Schedule 1 - Dictionary.

29. (29)
    having sepsis, or an injury or illness requiring admission to an intensive care unit or mechanical ventilation within the 30 days before the clinical onset of atrial fibrillation or atrial flutter;

    Note: sepsis is defined in the Schedule 1 - Dictionary.

30. (30)
    having infiltration of the myocardium due to: (a) amyloidosis; (b) haemochromatosis; or (c) sarcoidosis; at the time of the clinical onset of atrial fibrillation or atrial flutter;
31. (31)
    having an autoimmune or inflammatory disease from the specified list of autoimmune or inflammatory diseases at the time of the clinical onset of atrial fibrillation or atrial flutter;

    Note: specified list of autoimmune or inflammatory diseases is defined in the Schedule 1 - Dictionary.

32. (32)
    being overweight or obese for at least the 5 years before the clinical onset of atrial fibrillation or atrial flutter;

    Note: being overweight or obese is defined in the Schedule 1 - Dictionary.

33. (33)
    having obstructive sleep apnoea at the time of the clinical onset of atrial fibrillation or atrial flutter;
34. (34)
    having smoked tobacco products in an amount of at least 5 pack-years before the clinical onset of atrial fibrillation or atrial flutter; and if smoking has ceased before the clinical onset of atrial fibrillation or atrial flutter, then that onset occurred within 5 years of cessation;

    Note: one pack-year is defined in the Schedule 1 - Dictionary.

35. (35)
    having gastro-oesophageal reflux disease at the time of the clinical onset of atrial fibrillation or atrial flutter;
36. (36)
    having chronic renal failure at the time of the clinical onset of atrial fibrillation or atrial flutter;

    Note: chronic renal failure is defined in the Schedule 1 - Dictionary.

37. (37)
    having systemic chemotherapy for a malignant disease at the time of the clinical onset of atrial fibrillation or atrial flutter; (a) anthracyclines including doxorubicin; (b) HER2 inhibitors including trastuzumab; and (c) tyrosine kinase inhibitors including ibrutinib;

    Note: Examples of systemic chemotherapy for malignant disease include:.

38. (38)
    having glucocorticoid therapy as specified before the clinical onset of atrial fibrillation or atrial flutter, and if the glucocorticoid therapy as specified has ceased or decreased before the clinical onset of atrial fibrillation or atrial flutter, then that onset occurred within 30 days of cessation of therapy;

    Note: glucocorticoid therapy as specified is defined in the Schedule 1 - Dictionary.

39. (39)
    taking a non-topical, non-steroidal, anti-inflammatory drug, excluding low-dose aspirin, for a continuous period at least 30 days within the 60 days before the clinical onset of atrial fibrillation or atrial flutter;

    Note: low-dose aspirin is defined in the Schedule 1 - Dictionary.

40. (40)
    taking a drug from the specified list of drugs, within the 7 days before the clinical onset of atrial fibrillation or atrial flutter;

    Note: specified list of drugs is defined in the Schedule 1 - Dictionary.

41. (41)
    taking a bisphosphonate for a continuous period at least 30 days within the 60 days before the clinical onset of atrial fibrillation or atrial flutter;
42. (42)
    inhaling ambient, chronically polluted air as specified for at least 1 year, within the 2 years before the clinical onset of atrial fibrillation or atrial flutter;

    Note: ambient, chronically polluted air as specified is defined in the Schedule 1 - Dictionary.

43. (43)
    inhaling ambient, highly polluted air as specified for at least the 30 days before the clinical onset of atrial fibrillation or atrial flutter;

    Note: ambient, highly polluted air as specified is defined in the Schedule 1 - Dictionary.

    Note: Examples of causes of viral lower respiratory tract infections include severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and influenza virus.

44. (44)
    Having a viral lower respiratory tract infection within the 30 days before the clinical onset of atrial fibrillation or atrial flutter; Note; Examples of causes of viral lower respiratory tract infections include severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and influenza virus;
45. (45)
    having valvular heart disease at the time of the clinical worsening of atrial fibrillation or atrial flutter;

    Note: valvular heart disease is defined in the schedule 1 Dictionary.

46. (46)
    having ischaemic heart disease at the time of the clinical worsening of atrial fibrillation or atrial flutter;
47. (47)
    having non-infectious myocarditis at the time of the clinical worsening of atrial fibrillation or atrial flutter;

    Note: Non-infectious myocarditis can be acute or chronic.

    Note: Non-infectious myocarditis can be of autoimmune, infiltrative or immunological origin. Examples of causes of non-infectious myocarditis include immune checkpoint inhibitor therapy and giant cell myocarditis.

48. (48)
    having viral myocarditis at the time of the clinical worsening of atrial fibrillation or atrial flutter;

    Note: Viral myocarditis can be acute or chronic.

    Note: Examples of viral causes of myocarditis include severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and dengue virus.

49. (49)
    having a non-viral infection of the myocardium at the time of the clinical worsening of atrial fibrillation or atrial flutter;

    Note: Examples of causes of non-viral infection of the myocardium include Borrelia burgdorferi and leptospirosis.

50. (50)
    having pericarditis at the time of the clinical worsening of atrial fibrillation or atrial flutter;
51. (51)
    having cardiomyopathy at the time of the clinical worsening of atrial fibrillation or atrial flutter;
52. (52)
    having heart failure at the time of the clinical worsening of atrial fibrillation or atrial flutter;
53. (53)
    having hypertension before the clinical worsening of atrial fibrillation or atrial flutter;
54. (54)
    having pulmonary thromboembolism within the 30 days before the clinical worsening of atrial fibrillation or atrial flutter;
55. (55)
    having a thyroid condition from the specified list of thyroid conditions at the time of the clinical worsening of atrial fibrillation or atrial flutter;

    Note: specified list of thyroid conditions is defined in the Schedule 1 - Dictionary.

56. (56)
    consuming an average of at least 100 grams of alcohol per week for a continuous period of at least the 5 years before the clinical worsening of atrial fibrillation or atrial flutter;

    Note: Alcohol consumption is calculated utilising the Australian Standard of 10 grams of alcohol per standard alcoholic drink.

57. (57)
    binge drinking within the 2 days before the clinical worsening of atrial fibrillation or atrial flutter;

    Note: binge drinking is defined in the Schedule 1 - Dictionary.

58. (58)
    having a thoracic surgical procedure or an invasive cardiac procedure within the 1 year before the clinical worsening of atrial fibrillation or atrial flutter; (a) coronary artery bypass grafting; (b) heart transplant; (c) open heart surgery; and (d) transcatheter aortic valve implantation;

    Note: Examples of thoracic surgical procedures include vascular, mediastinal, pulmonary and chest wall surgery.

    Note: Examples of invasive cardiac procedures include:.

59. (59)
    having a non-cardiothoracic surgical procedure involving general or regional anaesthesia, within the 30 days before the clinical worsening of atrial fibrillation or atrial flutter;

    Note: Examples of non-cardiothoracic surgical procedures include emergency or elective orthopaedic and abdominal surgery and neurosurgery.

60. (60)
    having chronic obstructive pulmonary disease at the time of the clinical worsening of atrial fibrillation or atrial flutter;
61. (61)
    having asthma of sufficient severity to require maintenance therapy at the time of the clinical worsening of atrial fibrillation or atrial flutter;
62. (62)
    undertaking strenuous physical activity greater than 6 METs, for an average of at least 20 hours per week for a continuous period of at least the 5 years before the clinical worsening of atrial fibrillation or atrial flutter;

    Note: MET is defined in the Schedule 1 - Dictionary.

63. (63)
    inability to undertake any physical activity greater than 3 METs for at least the 1 year before the clinical worsening of atrial fibrillation and atrial flutter;

    Note: MET is defined in the Schedule 1 - Dictionary.

64. (64)
    having sick sinus syndrome at the time of the clinical worsening of atrial fibrillation or atrial flutter;
65. (65)
    having a benign or malignant neoplasm involving the cardiac atrium at the time of the clinical worsening of atrial fibrillation or atrial flutter;

    Note: A neoplasm involving the cardiac atrium can be primary or metastatic. An example of a primary neoplasm involving the heart is cardiac lymphoma.

66. (66)
    having a non-neoplastic lesion involving the cardiac atrium at the time of the clinical worsening of atrial fibrillation or atrial flutter;

    Note: Examples of non-neoplastic lesions which can involve the cardiac atrium include cardiac tamponade and coronary artery aneurysm.

67. (67)
    having a malignant neoplasm, excluding non-melanotic malignant neoplasm of the skin, at the time of the clinical worsening of atrial fibrillation or atrial flutter;
68. (68)
    undergoing a course of therapeutic radiation for cancer, where the heart was in the field of radiation, before the clinical worsening of atrial fibrillation or atrial flutter;
69. (69)
    having diabetes mellitus for at least the 5 years before the clinical worsening of atrial fibrillation or atrial flutter;
70. (70)
    experiencing penetrating trauma to the heart within the 1 year before the clinical worsening of atrial fibrillation or atrial flutter;
71. (71)
    experiencing a blunt chest injury within the 7 days before the clinical worsening of atrial fibrillation or atrial flutter;

    Note: blunt chest injury is defined in the Schedule 1 - Dictionary.

72. (72)
    having a spinal cord injury before the clinical worsening of atrial fibrillation or atrial flutter;

    Note: spinal cord injury is defined in the Schedule 1 - Dictionary.

73. (73)
    having sepsis, or an injury or illness requiring admission to an intensive care unit or mechanical ventilation within the 30 days before the clinical worsening of atrial fibrillation or atrial flutter;

    Note: sepsis is defined in the Schedule 1 - Dictionary.

74. (74)
    having infiltration of the myocardium due to: (a) amyloidosis; (b) haemochromatosis; or (c) sarcoidosis; at the time of the clinical worsening of atrial fibrillation or atrial flutter;
75. (75)
    having an autoimmune or inflammatory disease from the specified list of autoimmune or inflammatory diseases at the time of the clinical worsening of atrial fibrillation or atrial flutter;

    Note: specified list of autoimmune or inflammatory diseases is defined in the Schedule 1 - Dictionary.

76. (76)
    being overweight or obese for at least the 5 years before the clinical worsening of atrial fibrillation or atrial flutter;

    Note: being overweight or obese is defined in the Schedule 1 - Dictionary.

77. (77)
    having obstructive sleep apnoea at the time of the clinical worsening of atrial fibrillation or atrial flutter;
78. (78)
    having smoked tobacco products in an amount of at least 5 pack-years before the clinical worsening of atrial fibrillation or atrial flutter; and if smoking has ceased before the clinical worsening of atrial fibrillation or atrial flutter, then that worsening occurred within 5 years of cessation;

    Note: one pack-year is defined in the Schedule 1 - Dictionary.

79. (79)
    having gastro-oesophageal reflux disease at the time of the clinical worsening of atrial fibrillation or atrial flutter;
80. (80)
    having chronic renal failure at the time of the clinical worsening of atrial fibrillation or atrial flutter;

    Note: chronic renal failure is defined in the Schedule 1 - Dictionary.

81. (81)
    having systemic chemotherapy for a malignant disease at the time of the clinical worsening of atrial fibrillation or atrial flutter; (a) anthracyclines including doxorubicin; (b) HER2 inhibitors including trastuzumab; and (c) tyrosine kinase inhibitors including ibrutinib;

    Note: Examples of systemic chemotherapy for malignant disease include:.

82. (82)
    having glucocorticoid therapy as specified before the clinical worsening of atrial fibrillation or atrial flutter, and if the glucocorticoid therapy as specified has ceased or decreased before the clinical worsening of atrial fibrillation or atrial flutter, then that worsening occurred within 30 days of cessation of therapy;

    Note: glucocorticoid therapy as specified is defined in the Schedule 1 - Dictionary.

83. (83)
    taking a non-topical, non-steroidal, anti-inflammatory drug, excluding low-dose aspirin, for a continuous period at least 30 days within the 60 days before the clinical worsening of atrial fibrillation or atrial flutter;

    Note: low-dose aspirin is defined in the Schedule 1 - Dictionary.

84. (84)
    taking a drug from the specified list of drugs within the 7 days before the clinical worsening of atrial fibrillation or atrial flutter;

    Note: specified list of drugs is defined in the Schedule 1 - Dictionary.

85. (85)
    taking a bisphosphonate: for a continuous period at least 30 days within the 60 days before the clinical worsening of atrial fibrillation or atrial flutter;
86. (86)
    inhaling ambient, chronically polluted air as specified for at least 1 year, within the 2 years before the clinical worsening of atrial fibrillation or atrial flutter;

    Note: ambient, chronically polluted air as specified is defined in the Schedule 1 - Dictionary.

87. (87)
    inhaling ambient, highly polluted air as specified for at least the 30 days before the clinical worsening of atrial fibrillation or atrial flutter;

    Note: ambient, highly polluted air as specified is defined in the Schedule 1 - Dictionary.

88. (88)
    having a viral lower respiratory tract infection within the 30 days before the clinical worsening of atrial fibrillation or atrial flutter;

    Note: Examples of causes of viral lower respiratory tract infections include severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and influenza virus.

89. (89)
    inability to obtain appropriate clinical management for atrial fibrillation and atrial flutter;

Aggravation-only factors: the factors in subsections 9(45) to 9(89) apply only to material contribution to, or aggravation of, the condition where it was suffered or contracted before or during (but did not arise out of) the person’s relevant service.