BENGALURU: Atrial Fibrillation is the most common type of heart problem encountered in clinical practice accounting for one-third of all hospital admission-related to heart rhythm disorders. It is also one of the most important risk factors for stroke. It is a type of heart rhythm problem, characterised by irregular and chaotic heartbeat. AF is one of the most important risk factors for developing blood clots in the heart, which can travel to the brain causing a stroke.
AF is considered as a public health problem globally currently, accounting for approx. 37,574 million cases. Its prevalence has seen a steep rise by about 33 per cent in the last two decades and future projection suggests that this burden will further rise by >60 per cent in 2050. However, despite AF being an important cause of morbidity and mortality worldwide, its awareness and management remain suboptimal.
Establishing diagnosis
Some people suffering from AF may not experience any symptoms at all. Others may experience symptoms of heart palpitation, fatigue, lightheadedness or breathing difficulties. An electrocardiogram (ECG) in patients experiencing above symptoms or those with risk factors can help establish an early diagnosis and enable optimal management.
Stroke prevention
AF accounts for 25 per cent of all strokes and also increases the likelihood of stroke recurrence. Patients suffering from AF related stroke are more likely to suffer a greater level of disability or die, thereby posing a huge economic, emotional and social burden for both the patient and the caregivers.Eating a healthy diet low in sugar and fat, regular physical exercising, maintaining a healthy weight, controlling risk factors such as BP, cutting down on alcohol and smoking and reducing stress are some of the most effective ways to reduce the risk of AF and related stroke.
The cornerstone of AF management includes stroke prevention and oral anticoagulation therapy is the most effective means to prevent stroke in AF. Multiple studies have proven that anticoagulation therapy can cut down the risk of stroke by two-third, irrespective of the patient’s baseline risk. At present, most clinical guidelines recommend oral anticoagulation therapy in patients with moderate to high stroke risk, however evidence suggests that >50% of the patients do not receive treatment, exposing them to a high risk of stroke. Currently, a wide range of oral anticoagulation therapy is available in the market and the choice of agent depends on individual patient’s need and risk of bleeding side-effects.
(The writer is a consultant-interventional cardiologist, Manipal Hospitals, Old Airport Road
Risk factors
The most important causes of AF include advancing age, pre-existing heart conditions or risk factors such as hypertension, diabetes, thyroid disorders, etc. Rheumatic heart valve disease (heart complication arising due to rheumatic fever) is one of the most important causes of AF in the Indian population, accounting for 30-40% of the cases. The female gender also appears to be at slightly higher risk as compared to males counterparts.