Atrial fibrillation (AF) affects an estimated 2.3 million Americans every year, increasing their risk of stroke by nearly five times that of individuals without AF. To assess general awareness of and attitudes toward the link between AF and stroke, my colleagues and I conducted a survey that was fielded by Harris Interactive on behalf of Boehringer Ingelheim and the National Stroke Association. The national survey—called AFib STROKE (Atrial Fibrillation Survey To Reveal Opinions, Knowledge, and Education Gaps)—was conducted among 507 patients, 150 cardiologists, 150 primary care physicians, and 217 nurse practitioners in the United States in 2010.
It’s critical that clinicians capitalize on teachable moments and provide information in writing.
More than half (56%) of the patients in the AFib STROKE survey said that AF negatively impacted their lives. While 80% said they wanted to know more about AF and its relationship with stroke, 49% said they didn’t have a conversation with their physician about this link or didn’t remember anything specific about what was discussed when they received their AF diagnosis. About three-fourths of physicians reported having the conversation and educating their patients on the link between AF and stroke, indicating that there’s room for improvement from healthcare providers (see also, Updated Guidelines for Secondary Stroke Prevention).
Failing to See the Complete Picture of AF and Stroke
While physicians and patients generally may recognize some of the links between AF and stroke, they may not understand the full picture. For example, strokes associated with AF are twice as deadly as non-AF-related strokes, but less than half of healthcare providers surveyed were aware of this fact. About two in five patients (43%) said they feared the complications of stroke, but only 17% believed that they could die from complications of stroke.
Discussing AF Risks With Patients
When patients hear that they have AF, it’s important to inform them about their condition and ways to prevent future problems. Every patient requires a personalized treatment plan to either stop or manage AF, and hence, reduce the risk of future stroke. This means educating patients thoroughly, but it’s important to realize that there is a chance they won’t be able to retain all of the information they’re given. As such, it’s critical that clinicians capitalize on teachable moments and provide information in writing (see also, Increasing Awareness of Atrial Fibrillation).
There are a variety of trusted websites that can empower patients with AF, including www.facingafib.com, www.stopafib.org, and www.stroke.org. These resources should be given to patients as a prescription to ensure that they take measures to prevent future health problems. It’s also important to include a care influencer or caregiver in the conversation. About 60% of healthcare providers who treat patients with a care influencer believe that those patients are more informed about AF treatment and stroke risk.
Patients need to be educated on why they’re being prescribed a drug, if one is being given. Only one-third of patients in the AFib STROKE survey felt the most important goal of AF treatment was stroke prevention. Patients should be told about how blood clots can cause strokes so that they’ll adhere to the medications they’re prescribed. Therapies can reduce stroke risks by more than 80%. Informing patients about this may further motivate them to take action on their AF. All efforts to improve patient education will go a long way toward reducing the burden of this disease and preventing more serious problems later in life.
Readings & Resources (click to view)
Bloe C. Atrial fibrillation and primary stroke prevention. Nurs Stand. 2011;26:49-57.
Fang M. Selecting the optimal stroke prevention therapy in atrial fibrillation. Ann Intern Med. 2011;155:636-637.
Spence J. Free fatty acids and stroke from atrial fibrillation. Can J Neurol Sci. 2011;38:803.
Haft J. Continuum of cognitive impairment to stroke possibly via atrial fibrillation. Ann Neurol. 2011;70:606.
Wolf P, Dawber T, Thomas E, et al. Epidemiologic assessment of chronic atrial fibrillation and risk of stroke: the Framingham Study. Neurology. 2011;77:1579.
Potpara T, Lip G. Ischemic stroke and atrial fibrillation – a deadly serious combination. Cerebrovas Dis. 2011;32:461-462.
Tu H, Campbell B, Churilov L, et al. Frequent early cardiac complications contribute to worse stroke outcome in atrial fibrillation. Cerebrovas Dis. 2011;32:454-460.