Improved care needed for atrial fibrillation
About 2.6 million Americans have atrial fibrillation -- or Afib -- but many of them are not getting the kind of healthcare that could prevent a devastating stroke. A national initiative to improve the care of people with Afib was unveiled Tuesday that experts hope will mark a turning point in how the disorder is addressed.
The recommendations were drafted by representatives of more than 30 health organizations as part of the American College of Physicians Foundation’s Initiative on Atrial Fibrillation and Stroke Prevention.
Atrial fibrillation is a common problem in which the heart’s rhythm is abnormal. Afib is the leading preventable cause of stroke. About 20% of strokes are triggered by atrial fibrillation, and these strokes tend to be severe and disabling. About one in five people who have a Afib-related stroke die.
Moreover, the number of Americans with Afib is expected to grow rapidly, said Dr. Samuel Z. Goldhaber, professor of medicine at Harvard Medical School.
One of the reasons for the increase, he said, is that the field of cardiology “is so good at treating heart attack and the survival from heart attack has shot up,” leading to more people living with atrial fibrillation. “Also, it’s a disease of getting older.”
Among those 80 and older, 30% of strokes are due to Afib.
Strokes linked to atrial fibrillation should be easier to prevent than other types of strokes, Goldhaber said. But 90% of people with Afib don’t receive any anticoagulants or don’t receive them at the appropriate levels.
Warfarin is the traditional drug used to thin blood and prevent the clots that can cause stroke. But warfarin is a difficult medication to use. The advent of new drugs that are alternatives to warfarin should open the door to broader use of anticoagulants that could lower stroke rates, he said.
Two new anticoagulants are on the market: Pradaxa (dabigatran) and Xarelto (rivaroxiban), and several others are in development. Data from clinical trials show the stroke rate among patients on dabigatran is 34% lower compared to warfarin, and dabigatran doesn’t increase the risk of major bleeding as much as warfarin.
In a study published Monday, however, dabigitran was linked to a slightly high risk of heart attack compared to warfarin.
“We as physicians must balance this excess in [heart attack] with the stroke reduction and head-bleed reduction,” Goldhaber said.
“The novel oral anticoagulants are going to provide us with more choices, more convenience and less intracranial hemorrhage,” he said.
The new recommendations on treating Afib include tools to help doctors and patients weigh the risks and benefits of taking anti-coagulant medications, such as the risk of stroke versus the risk of bleeding. Besides medication, people with Afib need advice on healthy lifestyle habits that could also lower their risk of stroke.
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