The Balancing Act: Managing Atrial Fibrillation

Every year around 75,000 Americans learn that they have atrial fibrillation.  Some are diagnosed after noticing that their heart is racing or skipping beats. Others feel chest and throat pressure that they think is a heart attack. Or they go to their doctors feeling tired-out and weak all the time. Some feel nothing at all.

Atrial fibrillation is the most common type of arrhythmia—or abnormal heart rhythm.  Also referred to as afib, it’s a disorder involving the heart’s electrical system.  During episodes of afib, the heart’s upper chambers (the atria) beat irregularly and out of sync with the heart’s lower chambers (the ventricles).  In some people these episodes come and go.  In others they are chronic and occur regularly.  In both cases the abnormal heart rhythm itself isn’t generally serious; however, 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.

Serious & Costly Complications

In a normal heart, electrical impulses cause the different chambers to contract in an organized manner, pumping blood through the heart and out to the body.  During afib, chaotic and disorganized electrical impulses inefficiently pump the blood.  If severe, the body doesn’t get enough oxygen, which can lead to extreme fatigue and weakness.  The heart also ends up working overtime to try to compensate for the poor pumping and eventually becomes enlarged and diseased.  It can literally wear out and leave the person in congestive heart failure.  While the damage can often be repaired—and the heart even replaced—this is a serious complication that can be fatal.

The risk of stroke is also extremely high—around 15% of all strokes occur in people with afib.  The irregular heart rhythm doesn’t allow the heart to pump out all of the blood between beats.  Some of it can be left behind to pool and clot in the chambers of the heart.  A clot that forms in the heart can then be pumped out and lodge somewhere else in the circulatory system.  If that clot makes its way to an artery in the brain it blocks off blood flow and causes a stroke.  Strokes are often deadly and those that survive can face long-term disabilities.

This disorder and its complications are also expensive.  Every year, afib is the cause of around 350,000 hospitalizations, 5 million office visits, and 276,000 trips to the ER.  This obviously gets costly.  In 2001, the estimated cost of treating afib was $6.65 billion a year.  That number has no doubt grown in the last decade and doesn’t even begin to account for stroke prevention treatments, inpatient drug costs and physician fees, or indirect costs (like lost productivity due to missed work).

The Balancing Act

Treating afib involves restoring the normal rate and rhythm of the heart with medications or surgery, and preventing strokes with medications that thin the blood and make it less likely to clot.  Anticoagulants reduce the risk of stroke in afib patients by as much as 68%.  Unfortunately, they are rarely a simple solution.

There are new drugs entering the market that will offer more options, but for now warfarin is the most commonly used anticoagulant.  At the same time that it lowers stroke risk, it raises bleeding risk.  Unintentional injuries and cuts can cause bleeding since the body’s ability to clot is decreased by the drugs.  Internal bleeding, or hemorrhaging, can lead to serious problems if it happens in the GI system or the brain. 

This means that health care professionals must walk a tightrope when deciding how to treat afib patients—balancing the risk of stroke with the risk of bleeds.  Thankfully there are many tools available to help them do this.  These tools walk the health care professional through a list of sorts, assigning points for each risk factor.  Their final score helps decide if the risk of stroke outweighs the risk of bleeds—or the other way around.

The problem is that these tools are complicated, not always used by physicians, and missing critical risk factors—like increasing age.  This is why the Alliance for Aging Research has formed a task force for optimal treatment.  This task force is made up of patient and professional groups who will raise awareness of the disease, push for new treatment tools, and help experts form consensus on what should be in them.  Better treatment decisions will not only save lives but will lead to better lives with fewer appointments, hospitalizations, and disabilities.

To learn more about atrial fibrillation and managing stroke risk visit StopAfib.org and Stop the Clot.