Stroke and A-Fib: A Deadly Connection

Atrial Fibrillation Stroke and A Fib: A Deadly Connection Photo

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About 15 strokes every hour are caused by atrial fibrillation (A-fib), but most people don’t know what A-fib is – much less know if they have it.

A-fib occurs in an estimated 2.7 million Americans and is the most common type of irregular heartbeat (arrhythmia). A-fib dramatically increases the risk of stroke – approximately five times over the general population.

People with A-fib are more prone to strokes because of the irregular heart rhythms associated with the condition. A normal heart pushes all the blood through its ventricles each time it pumps. Yet, patients with A-fib can have a series of short contractions before a strong one.

It’s during these weaker pulses that the heart doesn’t empty, and the blood has an opportunity to pool, coagulate and clot.  That clot can travel out of the heart to block off blood supply to the brain, causing a stroke. These types of strokes, called embolic strokes, are twice as likely to be fatal or severely disabling as non-A-fib-related stroke.

Yet in the face of such dire news, most A-fib patients don’t know what they’re up against. According to a survey from the Heart Rhythm Society, National Stroke Association and Boehringer Ingelheim, two-thirds of patients said they were not aware of the fatality risks of A-fib-related strokes. More alarmingly, 32 percent of A-fib patients could not describe the most common symptoms of stroke.

Physicians surveyed in the same study overwhelmingly said that A-fib patients are in denial about their risk of experiencing a stroke. When asked about common barriers to patient education, physicians cited the following as the top three perceived challenges:

  1. Patient feels risk of A-fib-related stroke goes away once symptoms are being treated
  2. Patient thinks risks outweigh the benefits for medications reducing the risk of A-fib-related stroke
  3. Patient has trouble understanding what is being explained

However, there are differing perceptions. Over 90 percent of responding A-fib patients said they would do whatever their doctor recommended in order to reduce the risk of an A-fib-related stroke. Convenience also does not appear to be a barrier to treatment for the majority of patients: 92 percent of A-fib patients who have not experienced a stroke indicated it would not matter to them whether they had to take a treatment once or twice a day if it reduced the risk of stroke caused by a blood clot in the brain.

The survey demonstrates that doctor-patient conversations about A-fib and stroke need to improve.  As follow-up work, HRS and the National Stroke Association have established a working group of independent medical experts to review the findings and help create a roadmap to improve communication barriers between patients/caregivers and providers. Outputs from this working group will be made available through both organizations in early 2015.

“We hope our study will not only help raise awareness about the increased risk and severity of A-fib-related stroke, but also encourage smart, open conversations,” said David Frankel, MD, FHRS, Assistant Professor of Medicine at the Hospital of University of Pennsylvania and chair of the HRS AF-Impact of Stroke Survey Working Group.

People with A-fib can be put on anticoagulants to reduce the likelihood of a stroke. They can also be prescribed drugs to regulate the heart’s rhythm.

For more information about Atrial Fibrillation, see the Vitals Patient Guide.

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