Atrial Fibrillation: Stroke Prevention in Older Adults

Every year around 75,000 Americans learn that they have atrial fibrillation (AFib)—the most common type of arrhythmia, or abnormal heart rhythm.  While the abnormal heart rhythm itself isn't generally serious; abnormal blood flow and strain to the heart can lead to serious medical conditions.  These conditions can be deadly—having AFib doubles a person's risk of death. Visit the Alliance's Atrial Fibrillation page to learn more about the disease.

 Optimal Treatment Task Force

The Atrial Fibrillation (AFib) Optimal Treatment Task Force was formed by the Alliance for Aging Research, www.agingresearch.org, in 2011 to act as an umbrella group where organizations can collectively advocate for increased research and improved education on balancing stroke and bleeding risk in the treatment of AFib in older patients.  The Task Force is made up of patient and professional organizations who are working together to raise awareness of AFib, help experts form consensus on optimal risk assessment, and provide consistent messaging about AFib treatment.

Snapshot of AFib Optimal Treatment Task Force Activities

January 2011- In order to forge consensus on the best way to make anticoagulation decisions, the AFib Optimal Treatment Task Force convenes an expert roundtable in Washington, D.C.  The resulting consensus statement makes important recommendations on the use of stroke and bleeding risk tools, the decision to anticoagulate, and the incorporation of patient preferences. 

October 2011- The AFib Optimal Treatment Task Force proposes key questions on bleeding risk tools for inclusion in the Agency for Healthcare Research and Quality’s Effective Health Care Program comparative effectiveness review of anticoagulation treatments and stroke prevention in atrial fibrillation.  AHRQ included a version of these question in the final report.

March 2012- The AFib Optimal Treatment Task Force urges the Patient Centered Outcomes Research Institute (PCORI) to include topics on appropriate risk assessment in AFib treatment as part of PCORI’s developing national priorities for research. PCORI held a roundtable to develop targeted funding announcements for AFib treatment and invited two Task Force members to participate to shape these research opportunities.

September 2012- The AFib Optimal Treatment Task Force urges the Centers for Medicare and Medicaid Services to include a modified version of measure #1525, Chronic Anticoagulation Therapy, in the final rule for the 2013 Physician Quality Reporting System.

October 2014-The AFib Optimal Treatment Task Force convenes a symposium with representatives from federal agencies, patient advocacy groups, and medical professional societies to discuss those factors leading to undertreatment of elderly AFib patients and to produce a white paper identifying gaps in current clinical practice, outreach, education, research, and policy.

November 2015- The AFib Optimal Treatment Task Force calls on the Centers for Disease Control and Prevention to add specific Healthy People 2020 goals for stroke prevention in older patient with AFib.

March 2015- The AFib Optimal Treatment Task Force submits language to House and Senate Appropriations Subcommittees requesting inclusion of language in the FY16 Appropriations Bill.  The language urges NHLBI, NINDS, and other NIH agencies, institutes and offices to support PCORI and NIA's national initiative focused on falls prevention in older adults.  It also encourages CDC to focus its Vital Signs publication on best practices for stroke prevention in AFib patients.  This language was included in the final FY2016 Omnibus Appropriations Bill.

May 2015- The AFib Optimal Treatment Task Force submits a critical challenge on the need for improved bleeding risk assessment tools to the National Heart Lung and Blood Institute as part its strategic visioning process to identify priorities for future research.  This critical challenge was included in the final strategic plan released by NHLBI in August 2016.

How to Join the AFib Optimal Treatment Task Force

Now in its sixth year, the AFib Optimal Treatment Task Force continues to offer opportunities for collaboration, material dissemination, and joint advocacy. Membership in the Task Force is free; however, Task Force members are expected to:

  • Consider signing on to letters to policymakers;
  • Lend their organization’s logo for use on Task Force materials;
  • Participate on quarterly Task Force calls;
  • Disseminate Task Force partner materials to your organization’s members; and
  • Suggest content for the monthly Task Force newsletter on new initiatives, events or relevant research.

To join the Task Force, please contact Cynthia Bens, Vice President of Public Policy, at 202-688-1230 or email.

 

           

                                        

             

                   

 Expert Consensus

In order to forge consensus about the best way to make anticoagulation decisions, the AFib Optimal Treatment Task Force convened an expert roundtable in Washington, D.C. in January 2011.  To view the agenda and other meeting materials read the roundtable briefing book.

The resulting consensus statement makes important recommendations on the use of stroke and bleeding risk tools, the decision to anticoagulate, the incorporation of patient preferences, and more.  Read the full statement, an executive summary, or the press release to learn more about the consensus highlights.


 Advocacy

Submitted Comments

Sign-on Letter for AFib and Falls Prevention Language in FY16 Labor-HHS Appropriations Bill

The Alliance for Aging Research, along with Task Force partners Anticoagulation Forum, ClotCare, Heart Rhythm Society, Mended Hearts, Men's Health Network, National Stroke Association, OWL, Preventive Cardiovascular Nurses Association, Society for Women's Health Research, and StopAfib.org submitted suggested language to House and Sentate Subcommittees requesting inclusion of language in the FY16 Appropriations Bill.  The language urges NHLBI, NINDS, and other NIH agencies, institutes and offices to support PCORI and NIA's national initiative focused on falls prevention in older adults.  It also encourages CDC to use its Vital Signs publication to focus on best practices for stroke prevention in AFib patients.  Read the comments here.

AHRQ Key Questions for Stroke Prevention in Atrial Fibrillation Comments

On October 24, 2012, the Task Force members filed comments on key questions related to AHRQ's (Agency for Healthcare Research and Quality) Effective Health Care Program's comparative effectiveness review of stroke prevention in atrial fibrillation.  Read those comments here.

 

PQRS Proposed Rule for Revisions to 2013 Medicare Physician Fee Schedule Comments

On September 4, 2012, the Task Force members filed comments on CMS' (Centers for Medicare and Medicaid Services) Proposed Rule for Revisions to the 2012 Medicare Physician Fee Schedule.  Read those comments here.

 

PCORI National Priorities for Research Comments

On March 5, 2012, the Task Force members filed comments on PCORI's (Patient Centered Outcomes Research Institute) National Priorities for Research and Research Agenda.  Read those comments here.

 

AHRQ Effective Health Care Program Comments

On October 14, 2011, the Task Force members filed comments on AHRQ's key questions related to the EHC CER review of stroke prevention in atrial fibrillation.  Read those comments here.

 

 The Silver Book®

Learn more about how individuals, the health care system and the economy are impacted by atrial fibrillation in The Silver Book: Thrombosis and The Silver Book: Atrial Fibrillation fact sheet.

        

  

 

 Patient & Health Care Professional Surveys

Physician Survey

A survey of more than 400 geriatricians, internists and primary care physicians revealed a number of barriers to optimal AFib anticoagulation, including confusion when it comes to guidelines and tools, overemphasis of individual factors like frailty and risk of falls, and more.

Read the SURVEY HIGHLIGHTS or FULL RESULTS.

Patient Survey

A survey of more than 500 atrial fibrillation patients ages 65+ from across the nation revealed diagnosis and treatment experiences, information on anticoagulant use, stroke and bleeding risk discussions with health care professionals, and more.

Read the SURVEY HIGHLIGHTS or FULL RESULTS.

 Expert Podcast Series

This podcast series features interviews with leading experts in cardiology and neurology, and provides valuable background information on the anitcoagulation of atrial fibrillation (AFib) patients, including findings from the expert consensus statement Assessing Stroke and Bleeding Risk in Atrial Fibrillation.

 

Dr. Albert Waldo is the Walter H. Pritchard Professor of Cardiology, Professor of Medicine, and Professor of Biomedical Engineering at Case Western Reserve University School of Medicine in Cleveland, Ohio. In this podcast, he provides background on the recommendations of the expert consensus document, and additional information on anticoagulation including underuse, patient education, and the need for additional research.

Listen to the podcast.

 

Dr. Mark Alberts is a clinical vice-chair for the Department of Neurology and Neurotherapeutics at UT Southwestern.  Topics he discusses include stroke risk assessment and related scoring tools in both the US and Europe, the advantages of CHA2DS2-VASc, strengths and weaknesses of the leading tools and the effect of the new anticoagulants on them, and the impact of a patient's age in treatment.

Listen to the podcast.

 

Dr. John Camm is a professor of clinical cardiology and head of the Department of Cardiac and Vascular Sciences at St. George's Hospital Medical Center in London, U.K. In this podcast, he discusses bleeding risk assessment and related scoring tools.  He describes the commonly used tools in both the US and Europe, their strengths and weaknesses, patient demographic complications, and a host of other issues complicating assessment of bleeding risk.

Listen to the podcast.

 

Dr. Michael Ezekowitz is director of Atrial Fibrillation Research and Education at the Cardiovascular Research Foundation (CFR).  His discussion covers the changing landscape of new anticoagulants—including a comparison of currently available anticoagulants, aspirin use, which patients should use new anticoagulants, and the need for more data.

Listen to the podcast.

 

Dr. Jan Basile is a professor of medicine in the Division of General Internal Medicine and Geriatrics at the Medical University of South Carolina (MUSC) College of Medicine, and former chief of Primary Care Service Line at the Ralph H. Johnson VA Medical Center, both in Charleston, South Carolina.  His podcast lays out the U.S. and International guidelines on stroke prevention and risk assessment, as well as their similarities and differences.

Listen to the podcast.

 Sign Against Stroke

The Alliance for Aging Research joined with the more than 9,000 signees to the Sign Against Stroke Charter.  This charter was created to bring a worldwide, unified voice to improving the care and treatments of individuals living with AFib and AFib-related stroke.  Add your name to this growing list.

 Stroke Prevention in AFib Pocket Guide

This Pocket Guide outlines the similarities and differences in current AFib guidelines, as well as efforts from major medical organizations to guide decision-making for stroke prevention in AFib (SPAF).

 

 

 

 Call to Action to All Stakeholders

On October 16, 2014 the Alliance for Aging Research convened a symposium with representatives from federal agencies, patient advocacy groups, and medical professional societies to discuss those factors  leading to undertreatment of elderly AFib patients and to identify gaps in current clinical practice,  outreach, education, research, and policy.

Symposium participants concluded that an integrated, national effort is needed to promote adoption of  best practices, develop alternate reimbursement models, expand patient and caregiver education on stroke risk and treatment, leverage existing initiatives, and address gaps in research on stroke and bleeding in AFib.  Read the full whitepaper here.