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The Increasing Burden of Atrial Fibrillation

The Increasing Burden of Atrial Fibrillation

Research suggests that atrial fibrillation (AF) is the most common heart rhythm disorder, but the global burden of AF has not been estimated until recently. The World Health Organization (WHO) assesses the global burden of many public health concerns every 20 years through its Global Burden of Disease Project, but AF was not included in 1990 when the project was last conducted. To establish the global and regional prevalence of AF—in addition to its associated incidence and mortality rates—Sumeet S. Chugh, MD, FACC, FHRS, FAHA, and colleagues systematically reviewed nearly 200 population-based studies of AF. Worldwide Findings “The most important metric that WHO established for understanding the burden that a disease imposes on society is disability-adjusted life-years (DALYs),” explains Dr. Chugh. He and his colleagues found that the burden associated with AF, measured in DALYs, increased by nearly 19% in both men and women between 1990 and 2010 (Figure 1). An estimated 33.5 million men and women had AF across the globe in 2010. The estimated age-adjusted, global prevalence rates per 100,000 population increased from 569.5 in 1990 to 596.2 in 2010 for men and from 359.9 in 1990 to 373.1 in 2010 for women. In addition, the overall incidence (Figure 2) and associated mortality rates (Figure 3) increased significantly for both genders during the study period. “AF is not a condition that directly leads to death,” notes Dr. Chugh. “However, it keeps company with many heart conditions that do.” On the Local Level It is well understood that patients are getting older, not only because of the baby boomer generation but also because survival rates among patients who...
Managing AF: A Look at Treating Specialty

Managing AF: A Look at Treating Specialty

About 2.3 million Americans are affected by atrial fibrillation and atrial flutter (AF), a condition that causes 15% of the 700,000 strokes that occur annually in the United States. Anticoagulants like warfarin can help prevent stroke in AF patients, but these therapies can also cause bleeding in some cases. “Prediction tools, such as the CHADS2 score, have been developed to estimate stroke risk and are now recommended by clinical guideline statements,” says Mintu P. Turakhia, MD, MAS. “These guidelines, however, vary considerably in describing how stroke and bleeding risk should be evaluated and integrated into clinical decision making.” Assessing Potential Variations in Warfarin Use It has been suspected that use of warfarin in AF may vary by specialty and over time. In the American Heart Journal, Dr. Turakhia and colleagues had a study published that evaluated differences and trends in warfarin prescription by treating specialty for new AF cases. Using VA data from the TREAT-AF study, the investigators reviewed more than 141,000 participants with newly diagnosed AF in which patients had at least one internal medicine, primary care, or cardiology encounter within 90 days of their diagnosis. The primary outcome was prescription of warfarin. According to results, care of patients with new AF from cardiologists appeared to be associated with a greater likelihood of warfarin prescription when compared with care only from primary care physicians (Table 1), even after adjusting for covariates and a propensity for cardiology care. The observation was also consistent across subgroups of patients, including those who were at lowest risk for bleeding. Furthermore, warfarin prescriptions were more frequently provided to those at highest risk for stroke,...
Heart Rhythm eBook

Heart Rhythm eBook

We are proud to present this monograph comprising several feature articles — including Psychological Distress, Predicting AFib, and Cardiac Rhythm Abnormalities — that are applicable to cardiologists and other healthcare providers. Created with the assistance of key opinion leaders and experts in the field, these articles explore challenges and opportunities in cardiology and strategies to positively change current practices. In  upcoming months, Physician’s Weekly will continue to feature topics that affect cardiologists and other healthcare...

Predicting Atrial Fibrillation After CABG

Postoperative atrial fibrillation (AF) occurs in 15% to 30% of patients who undergo isolated CABG. Patients who develop AF after these procedures are at risk for longer hospital stay, perioperative morbidity and mortality, and long-term mortality. Identifying specific patients who are at high risk for developing AF after CABG may help define a population that is more likely to benefit from antiarrhythmic drugs or other AF prevention strategies. Evaluating a Simple AF Risk Model Previous analyses of patients undergoing CABG have suggested that certain preoperative, intraoperative, and postoperative factors can be used to determine the risk of postoperative AF (POAF), but these models can be cumbersome to apply and may not always be useful. In the American Journal of Cardiology, my colleagues and I had a study published that tested a simplified clinical tool using preoperative patient characteristics to identify those at high risk for POAF following CABG. Using the Society of Thoracic Surgery database, we identified a subset of preoperative variables that predispose patients to POAF. Using these variables, we created a risk index that had a moderate prediction power to identify patients at high risk of developing POAF. Patients were assigned point values according to the AF Risk Index Table. Patients scoring 4 points on the AF risk index had a 30% to 40% chance of developing POAF. Conversely, those with a score of 0 points had a less than 10% risk. “Identifying specific patients who are at high risk for developing AF after CABG may help define a population that is more likely to benefit from anti-arrhythmic drugs or other AF prevention strategies.” Mikhael F. El-Chami, MD...
The Impact of Psychological Distress on Atrial Fibrillation

The Impact of Psychological Distress on Atrial Fibrillation

Atrial fibrillation (AF) is the most common arrhythmia in adults and is rapidly reaching epidemic proportions in the United States. Recent studies have suggested that treatment of AF correlates with enhanced overall quality of life. According to current guidelines, the choice of management strategy for AF should be guided by the symptomatic status of patients due to AF. Despite the emphasis being placed on relief of AF symptoms, several smaller investigations have suggested that psychological distress may be linked with patient-reported AF symptom severity. Some analyses have shown that patients with AF have a high prevalence of anxiety and depression. It’s possible that depression and anxiety may be more important than the number or duration of AF episodes in predicting AF symptom severity. These conditions may also be important predictors of worsened outcomes in patients with AF. Few studies, however, have investigated the association between anxiety and depression and severity of symptoms that patients attribute to AF. Intriguing New Data on Patients with Atrial Fibrillation To determine whether psychological distress is an important factor in patient-reported AF symptom severity, my colleagues and I performed a study—published in the Journal of Cardiovascular Electrophysiology—that examined the issue in greater detail. A cohort of 300 outpatients with stable AF was screened for symptoms of anxiety, depression, and somatization disorder. They also completed questionnaires that assessed general health and well-being, specifically measuring disease-specific AF symptom severity. Overall, patients in the study with worsened severity of depression, anxiety, or somatization disorder symptoms had an increase in AF symptom severity regardless of the AF severity scale used (see Figure). In addition, greater severity of depression...
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