Around 1.3 million people in the UK have been diagnosed with atrial fibrillation, and it’s estimated that there are many more living with it undiagnosed – but why are the statistics not catalysing greater public concern? SPR – with help from the British Heart Foundation – explores the need for, and current work in, enhanced detection and management.
Atrial fibrillation (AF) is one of the most common abnormal heart rhythms. In a normal heart the heart’s pumping action is controlled by regular electrical messages produced by part of the heart called the sinus node. However, AF occurs when additional, irregular electrical messages are sent from other places in and around the atria (the upper chambers of the heart). These irregular messages make the atria quiver or twitch, which is known as fibrillation.
AF can increase the risk of a blood clot forming inside the heart. If the clot is swept up out of the heart and into the blood vessels of the brain, it can cause a stroke. AF increases the risk of a stroke by around four-to-five times.
Searching for the Signs
Karen McCammon, Health Service Engagement Lead with British Heart Foundation (BHF) Northern Ireland, has explained that many people with AF have no symptoms.
‘AF leads to an increased risk of stroke, heart failure, vascular dementia, hospitalisations, and, in some cases, death. The most common symptoms are palpitations, breathlessness, dizziness, and syncope. However, as many as 25-to-30 per cent of people do not have symptoms,’ she said.
‘This means that many patients fail to present for treatment, despite having a greatly elevated risk of stroke.’
A Quest for Improvement
BHF Professor, Barbara Casadei, combines her role as a heart doctor at the John Radcliffe Hospital in Oxford with pioneering research to improve our understanding of AF. Her team at the University of Oxford have found that changes in the heart muscle of the atria start before AF occurs, and could be a cause of it. AF tends to come and go before it becomes persistent.
The team have found that in cases where AF is persistent, the atria have lower levels of two proteins – ‘dystrophin’ and ‘neuronal nitric oxide synthase’. Professor Casadei is studying whether these changes can be prevented or reversed to stop AF from occurring and becoming persistent.
Karen said, ‘BHF is the biggest independent funder of heart and circulatory disease research in the UK. All of our work is due to public support because we don’t receive any government funding. Professor Casadei’s work is just one of many BHF-funded projects happening throughout the UK researching AF.
‘We have made history in research and believe that by improving our understanding of AF and finding new ways to treat it, fewer people will be at risk of heartbreak from a stroke.’
Time for Action
BHF believes that the key to improving the lives of people living with AF right now is the assessment and management of the condition.
‘Initial priority must be to ensure those patients with known AF are managed appropriately, and as per NICE guidelines, which will improve patient outcomes and decrease the number of AF-related strokes locally,’ Karen explained.
‘Importantly, the risk of someone with AF having a stroke can be reduced by treatment with anticoagulation medication. Appropriate use of anticoagulation can reduce stroke risk in AF by two-thirds.
‘Unfortunately, there is currently no cure for most cases of AF. NICE guidelines recommend that the first consideration when treating AF should be a decision on the need for anticoagulation medication to reduce the person’s risk of stroke.
‘Anticoagulation medication is a well-evidenced way to reduce the risk of AF-related strokes. Not everyone with AF has the same risk of stroke. The presence of certain factors increases the risk of an AF-related stroke and this risk can be assessed using checklist scoring systems.’
In Harm’s Way
While stroke is the most common complication, AF is associated with a number of other conditions, including heart attack and dementia. Less is understood about AF and these complications, but recent studies suggest that anticoagulant medications can reduce the risk.
Karen has said that BHF Northern Ireland is currently working to improve the lives of those living with AF.
‘The national screening committee currently do not recommend screening for AF; however, there is a study underway to determine if there would be a benefit to this. Until we know the results of that we should use every opportunity to improve AF management for those individuals living with this condition.
‘We are currently working to support the delivery of a structured AF educational programme, new care models / pathways to support healthcare professionals and anticoagulation monitoring and decision-making tools – incorporating the patients lived experience to guide how best to improve AF management and patient outcomes.’
For more information on AF, visit www.bhf.org.uk/informationsupport/conditions/atrial-fibrillation. To contact Karen McCammon, email firstname.lastname@example.org.
By the Numbers
• AF is a contributing factor to one-in-five strokes
• There are more than 100,000 strokes in the UK each year
• That is a stroke at least every five minutes