ATRIAL FIBRILLATION IS A VERY COMMON CHRONIC DISEASE BUT HARD TO DETECT
WHAT IS ATRIAL FIBRILLATION (AF)?
Atrial fibrillation (AF) is the most common abnormal heart rhythm. In a normal heart, the four chambers of the heartbeat in a steady, rhythmic pattern. With AF, the atria (upper chambers of the heart) fibrillate (quiver or twitch quickly) and create an irregular rhythm.
This irregular heart rhythm can lead to symptoms that negatively impact the quality of life in some people. Others experience no symptoms at all. AF itself is not life-threatening. If left untreated, however, the side eﬀects of AF can be life-threatening, leading to stroke or heart failure. This makes identifying and treating AF so important.
AF increases a person’s risk for stroke by four to ﬁve times compared with stroke risk for people who do not have AFib. Strokes caused by complications from AFib tend to be more severe than strokes with other underlying causes. AFib causes 15%–20% of ischemic strokes, which occur when blood ﬂow to the brain is blocked by a clot or by fatty deposits called plaque in the blood vessel lining. More than 750,000 hospitalizations occur each year because of AFib. The condition contributes to an estimated 130,000 deaths each year. The death rate from AFib as the primary or a contributing cause of death has been rising for more than two decades.
[Source : The AF Report; Atrial Fibrillation: Preventing A stroke Crisis, AFA]
AF is frequently intermittent and many people with AF have no or non-specific symptoms. These combine to make detection and diagnosis difficult; often, AF is not apparent until a person goes to see their doctor with a serious complication such as stroke, a blood clot in the leg or heart failure.
Even patients who do experience symptoms of AF are not always diagnosed immediately. In a recent international survey, there was an average delay of 2.6 years between the onset of symptoms and the diagnosis of AF. In another piece of research, among patients with documented chronic AF, it was found that more than a third were not aware of their diagnosis and up to half were unaware of why they were being treated. This indicates that many patients with AF are not being detected or managed effectively and that many are at risk of serious long-term consequences such as stroke.
silent danger of
potential threat to public health
Independent of this increase in the prevalence of AF over time in our society, the number of people with AF have been shown to double with each advancing decade of age, from 0.5% at age 50-59 years to almost 9% at age 80-89 years. Not surprisingly, the incidence of AF also increases with age, contributing to the growing prevalence. Among many damaging and debilitating consequences, AF increases an individual’s risk of suffering a stroke by ﬁve times. This effect alone results in considerable disability and death, not to mention avoidable millions in healthcare expenditure that the National Health Service (NHS) cannot afford.
For example, in patients with AF, who are known to have a high risk of stroke, the cost of treating a stroke has been calculated to be almost four times greater than the cost of prevention with ten years’ anticlotting therapy.
[Source : Stroke Prevention in Nonvalvular Atrial Fibrillation]
Stroke accounts for a massive burden on patients, their carers, families, friends, and society. This burden falls disproportionately on the elderly, who are most at risk. Early diagnosis and effective management of Atrial ﬁbrillation would help to reduce the burden of stroke.
Furthermore, the prevention of stroke with existing, cost-effective therapies in patients at high risk has the potential to reduce this huge economic burden signiﬁcantly. With both AF prevalence and AF death rates increasing, there is an urgent need to improve the management of AF, in particular, to prevent the most common fatal consequences, such as stroke.