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
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
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...