Preventive care for atrial fibrillation currently ‘less than ideal’

New research from the University of Queensland (UQ) has emphasised the need to treat atrial fibrillation (AF) as a chronic disease in primary care and highlighted that effective treatments are sometimes being overlooked, especially early on.
 
The study, led by Dr Linh Ngo from UQ’s Faculty of Medicine, found 45% of patients admitted to hospital for AF in Australia and New Zealand die within 10 years.
 
Dr Ngo said AF is closely associated with strokes.
 
‘But we know much less about the risk of recurrent hospitalisations and other consequences such as heart failure or death,’ he said.
 
‘Unfortunately, we found only 55.2% of patients hospitalised with AF survived beyond a decade.’
 
The analysed data included more than 250,000 patients admitted with AF, and the closely related condition atrial flutter, to all public and most private hospitals from 2008–17 in Australia and New Zealand.
 
Co-author and cardiologist Associate Professor Isuru Ranasinghe said their findings shows that AF needs to be treated as a chronic disease ‘with multiple downstream consequences’.
 
‘The literature also suggests many patients at high risk of a stroke fail to receive blood thinning medications, so current preventive efforts are far from ideal,’ he said.
 
‘Better patient education in areas such as blood pressure control and weight loss, as well as appropriate preventive therapy in hospital and primary care could improve the outcomes for people with AF.’
 
Dr Ranasinghe also said fewer than 7% of patients had a catheter ablation procedure during the decade studied, one of the most effective treatments for patients with symptomatic atrial fibrillation.
 
‘It may mean this procedure was underused in Australian and New Zealand hospitals,’ he said.
 
GP and Melbourne University academic Associate Professor Dr Ralph Audehm told newsGP that people with AF not receiving anti-coagulation medication is a considerable problem.
 
‘There are obviously a lot of people falling between the gaps and not being anticoagulated and that’s really important,’ he said.
 
‘We just need to refocus, make sure that patients who are in AF have some form of anticoagulation and then, depending on other comorbidities, we should refer them to a cardiologist who has an interest in AF as to whether ablation would be the preferred approach.’
 
Associate Professor Audehm, who has helped create national guidelines for heart failure, said non-vitamin-K-antagonist oral anticoagulant (NOACs) have changed the face of anticoagulation medication and drastically improved outcomes for patients.
 
‘That’s not suitable for everyone, but the vast majority should be able to go on some form of anticoagulation,’ he said, adding that the debate around the best treatments for AF has changed over the years.
 
‘Over the last few years, the pendant seems to be swinging more towards rhythm control having better long-term outcomes,’ he said.
 
‘The message here would be for our patients in persistent AF, getting a cardiology opinion about whether they should be rate or rhythm controlled is really critical because the technology around the ablations has improved dramatically and can lead to great outcomes.’
 
But Dr Audehm said lifestyle ‘does have a big role to play here’.
 
‘The other thing that GPs can do is look at the risk factors around exercise, nutrition and weight and support them in making changes,’ he said.
 
Log in below to join the conversation.

atrial fibrillation blood-thinning medication cardiovascular disease chronic disease coronary disease heart disease heart failure heart health prevention stroke