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The Shifting Treatment Landscape in Atrial Fibrillation

The Shifting Treatment Landscape in Atrial Fibrillation

Atrial fibrillation (AF) is a disorder found in approximately 2.2 million Americans, and the number of people with AF in the United States is expected to double over the next 30 to 40 years (Figure). Published data have estimated that about 15% of all strokes occur in people with AF, and the risk factors for stroke in patients with nonvalvular AF are substantial. The likelihood of developing AF increases with age, and data suggest that 3% to 5% of people 65 and older have the condition. “AF impacts the elderly substantially because they typically have more comorbidities,” says Gerald V. Naccarelli, MD. “This has raised concern over how to manage these patients.” According to the National Heart, Blood, and Lung Institute, AF is more common in people with coronary heart disease, heart failure, rheumatic heart disease, structural heart defects (eg, mitral valve disorders), pericarditis, congenital heart defects, and sick sinus syndrome. AF also is more common in people with heart attacks or who have just had surgery. Other conditions that increase AF risk include hyperthyroidism, obesity, hypertension, diabetes, and lung disease (Table 1). “The increasing incidence of AF has raised awareness of the importance of stratifying stroke risk,” Dr. Naccarelli says. “The key for clinicians is to determine who should receive anticoagulation and who should not [Table 2]. Unfortunately, studies show that about half of people with AF who are candidates to receive vitamin K antagonists (VKAs), such as warfarin, are not receiving the drug. Of that half, only two-thirds of these patients are actually taking VKAs as prescribed.” Emerging Drugs VKAs, most notably warfarin, have long been used...
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