Risk of Stroke

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Global survey reveals need for more awerness

The SPEAK about AF Survey (Stroke Prevention, Education, Awareness and Knowledge), the largest and most extensive ever conducted in people diagnosed with atrial fibrillation and the physicians who treat the condition, revealed that more education is needed about the link between atrial fibrillation and stroke.  Over 3,700 people globally were surveyed including people with atrial fibrillation, cardiologists, neurologists and general practitioners.

The survey found that the majority of physicians and more than half of people with atrial fibrillation stated that the condition has a negative impact on quality of life. Key findings from the survey suggested that whilst healthcare professionals are aware of the link between atrial fibrillation and stroke, not all people with the condition fully realised they were at risk.

Both people with atrial fibrillation and physicians agreed that there was a need for more information about the risk of atrial fibrillation-related stroke, with some people stating that they felt more informed and confident as they learnt more about their condition over time.

What causes atrial fibrillation?

The risk of atrial fibrillation increases as you get older. It affects 1% of adults worldwide. One in four people aged 55 will develop the condition.1,2 Atrial fibrillation is more common in people who have heart disease or heart-related conditions like heart failure. It is very uncommon in children.3,4

Whilst some cases of atrial fibrillation have no known cause, conditions and lifestyle factors known to trigger atrial fibrillation are:3,4

  • High blood pressure
  • Being obese or overweight
  • Diabetes
  • Having an overactive thyroid gland
  • Lung cancer
  • Drinking too much alcohol or binge drinking

How does atrial fibrillationlead to stroke?

Strokes happen in atrial fibrillation when pools of blood form in the heart because of the upper chambers of the heart (the atria) not contracting properly. Blood sticks together in the atria and forms clots which can travel through the bloodstream and block blood flow to the brain, causing a stroke.1,2

A stroke is the brain equivalent of a heart attack. Blood must flow to and through the brain for it to work properly. If this flow is blocked by a blood clot, the brain loses its energy and oxygen supply, causing brain damage that can lead to disability or death.3

Atrial fibrillation is one of the most important risk factors for stroke.3 People with atrial fibrillation are five times more likely to have a stroke than someone without the condition4 and up to three million people have a stroke related to atrial fibrillation each year.3,5,6

Atrial fibrillation-related strokes tend to be more severe, disabling and deadly than other kinds of stroke.5 Therefore, atrial fibrillation-related strokes are a huge burden for family and national healthcare services. In fact, atrial fibrillation-related strokes cost healthcare systems across Europe and the United States over €11 billion per year.7,8

The physical and emotional burden of atrial fibrillation

Atrial fibrillation often has a negative impact on people’s lives, reducing their physical and mental wellbeing. Often, people diagnosed with the condition feel anxious or scared and, for many, symptoms become worse with time which can severely affect their ability to carry out simple daily tasks. According to the SPEAK about AF Survey, over half of people with atrial fibrillation agreed (64%) that they have become less active since being diagnosed. Their ability to participate in physical activities (51%) or undertake other physical activities such as regular household chores (26%) or travel (22%) are some of the areas mostly affected. Consequently, people can suffer from feelings of depression, denial and anger at the injustice of their ‘normal’ life being taken from them.

Atrial fibrillation is a very unpredictable disease. People are often reluctant to travel and may avoid social engagements altogether, fearing they may experience atrial fibrillation symptoms.  Frequent hospital visits cause additional disruption and distress to sufferers and their families’ lives.

Many people do not understand atrial fibrillation, as symptoms are not visible to the outside world. As a consequence, employers, family members, friends and even physicians may be unaware of the impact that atrial fibrillation has on people’s ability to function normally. In turn, they may seem unconcerned and unsupportive.  As a result, people with atrial fibrillation often worry that others will accuse them of exaggerating their symptoms.

For those people who are aware that atrial fibrillation can lead to stroke, the risk is an ever present threat. Many people with atrial fibrillation live with a constant fear about what the future might hold, worrying not only about their personal fate but even more about becoming a burden on their families should they have a stroke.

Atrial fibrillation- an increasing problem

1. Miyasaka Y et al. Circulation 2006;114:119-25
2. Fuster V et al. Circulation 2006;114:e257-354
3. Friberg J et al. Epidemiology 2003;14:666-72
4. Ringborg A et al. Europace 2008;10:403-11
5. Coyne KS et al. Value Health 2006;9:348-56

Treating atrial fibrillation

Managing atrial fibrillation focuses on reducing the risk of stroke through “blood thinning” or antithrombotic medication and, secondly, by trying to restore a normal heart rate or rhythm.

Antithrombotic treatment

People with atrial fibrillation at risk of stroke are usually asked to take medication to thin the blood to reduce the chance of blood clots forming. This is called antithrombotic treatment and comprises antiplatelet and anticoagulant medications.  Anticoagulant therapy is indicated for patients at moderate to high risk of stroke. Vitamin K antagonists (VKAs) such as warfarin are commonly used as anticoagulant medication.

VKAs are very effective with long-term use, preventing two out of three strokes in patients with atrial fibrillation.1 However, VKAs can be a difficult medication for people to take as it can interact with other common medications and certain types of food. Patients treated with VKAs need to be monitored carefully by their doctor who must carry out frequent lifelong blood tests and make adjustments to the dose to ensure treatment remains effective.

People with atrial fibrillation at low risk of stroke or who cannot tolerate warfarin are usually given the antiplatelet agent aspirin, which is not as effective as warfarin for stroke prevention.

Rate control treatment

Some patients with atrial fibrillation who have a fast heart rate are given medication to help bring their heart rate back to normal.  This usually improves symptoms such as dizziness.  This type of treatment is called rate control.

Rhythm control treatment

To selected patients the doctor may offer a method called electrical cardioversion that gives the heart an electric shock to bring the rhythm of the heart back to normal.  Restoration of the sinus rhythm can also be induced by pharmacological methods of cardioversion. This is called rhythm control treatment.

Living with atrial fibrillation

How to talk to your doctor about atrial fibrillation

Visiting the doctor

Working in partnership with your doctor is a very important factor in making sure your health is as well protected as possible. You’ll find advice here on ensuring you’re helping your doctor to help you.

Working positively with your doctor

Pretending atrial fibrillation (AF) doesn’t exist is not an option. Facing up to AF by  taking a positive and proactive role in managing your health will make you feel less of a victim of a medical condition, and more of a person who is prepared to stand up for their own health and wellbeing.  The first step to giving yourself the best chance of keeping healthy is by working in partnership with your doctor, and by following your doctor’s advice.

As well as prescribing the best treatment for your AF, your doctor will be able to help with any questions or concerns you might have regarding your condition and any implications it will have to your lifestyle.  It’s likely that a primary care doctor will be the first person to diagnose and then treat your AF. You may then be referred to a specialist heart doctor, or cardiologist.

Doctor discussion aid

There is a lot to think about when you visit the doctor. Here is a doctor discussion aid tool with a list of questions you might find useful to have answered. Why not print this list and take it with you on your next visit?

What if you feel your visit did not help you?

Sometimes medical words can be used which are difficult to people without medical knowledge. If you found this, you might find our Glossary helpful in understanding the medical terms.

Next steps

It is perfectly alright to ask for another appointment, to discuss the same issue again. Sometimes it is useful to write down what you want to say before you visit the doctor. And you might find our doctor discussion aid tool could be useful in helping you next time you see your doctor. Also taking a friend or family member with you for moral support, and to understand what is going on, is a good idea.

I don’t understand the advice my doctor is giving me

Occasionally it’s all too easy to lose track of what the doctor is telling you. If you feel you don’t understand your doctor’s advice why not try these ideas?

  • Ask for another appointment – it’s perfectly okay to ask your doctor to explain his / her advice again.
  • Take a friend – asking a friend or family member to accompany you for moral support and to help you understand your doctor’s advice is an excellent idea.
  • Take notes – use a notebook to write down your doctor’s advice while you’re in the doctor’s office. Your doctor won’t mind it at all, and you can look at it again afterwards and talk to other people about it.
  • Use our doctor discussion aid tool – to help you understand the questions you can ask your doctor.
  • Use our Glossary to help demystify that medical jargon.

You might find that patient groups are also helpful if you’re finding it difficult to understand your doctor’s advice.

New prescription?

Going to your doctor can be daunting, especially if you are given lots of new information or a new prescription.

It may be that you have been prescribed a medication but you are not sure why, or what it does. This may be because you have developed a new medical condition, or that a new treatment has become available and your doctor has chosen it as the best option for you.

So what should you do to find out?

Firstly, it is important that if you have been prescribed a medicine you should take it, and not suddenly stop without discussing this with your doctor. The doctor will have prescribed the treatment for a good reason so if you are unsure what the treatment is for, or how to take it, the best thing to do is just to ask again.

Your doctor knows that making sure you understand why you have been prescribed a medicine is important and will be able to help you with all the information about your new prescription.

If you have any concerns about the treatment you have been prescribed it is important that you talk to your doctor before you stop taking a medication your doctor has prescribed.

Atrial fibrillation and travel

Discover some top tips for travelling if you have AF, to help you minimise any risks.

Top tips for travellers with AF1

  • Tell your doctor. It’s wise to talk to your healthcare professional before setting off on holiday.
  • Keep your medication with you when you travel. If you are taking medication for your AF, pack extra doses and be sure not to put them in your checked-in baggage. Should your baggage go astray, you’ll at least have your medications with you. Also, be sure that you store your medications as recommended in the label.
  • Take a list of your prescriptions in case you lose them and have a medical emergency. Your healthcare professional may also be able to suggest a local physician to contact if needed. 

Health insurance

If you are visiting another country you need to ensure you are covered for any necessary medical treatment during your time there. You will need to apply for travel/health insurance or contact your current insurer to check the terms and conditions of what you are covered for.