The heart disease type that’s bucking downward trends

The most recent figures on Australia’s leading causes of death reveal that while overall mortality from heart disease has been in steady decline over the past decade, deaths from one particular type of heart disease have been increasing at a rate of 5.6% per year.
 
That type of heart disease is atrial fibrillation (AF), an irregular heartbeat that raises the risk of stroke and heart failure – and its rates within the Australian population are expected to rise even further in the future, for three key reasons.
 
‘One is the changing demographics, that is that the community’s getting older, and this [disease] is associated with ageing,’ Heart Foundation Chief Medical Advisor, Professor Garry Jennings told newsGP.
 
‘Secondly, it’s one of the consequences of our success in treating heart disease in younger people – more people are living with heart disease.

‘The third and perhaps the newest thing is that recent research has pointed to lifestyle factors making AF more likely, and that’s particularly hypertension, obesity, diabetes.
 
‘So all of these things are working towards this quite substantial increase we’re seeing year on year in the prevalence of AF in our community.’
 
Because AF is so strongly associated with chronic conditions such as diabetes, coronary heart disease and obesity, it can be positively impacted by modifying lifestyle factors.
 
‘This includes following a heart-healthy lifestyle by eating nutritious foods, exercising, avoiding smoking, and maintaining a healthy weight,’ Professor Jennings said.
 
‘The link between AF and conditions such as high blood pressure and diabetes is another good reason to keep these conditions under control and manage your stroke risk.’
 
Professor Jennings believes the importance of lifestyle factors in the management of AF makes GPs, who see patients on a regular, long-term basis, key in the effort to bring down the mortality numbers for this disease.
 
‘There’s considerable controversy in the field as to whether we should do routine screening for AF in the community, or whether it’s something that should be done opportunistically,’ he said.
 
‘But given that most people go to a GP most years, this can be done in the context of a normal physical examination.’
 
It is particularly vital for GPs to ensure regular checkups with older patients, as AF can often go undetected.
 
‘We know that probably for everyone out there who knows they have AF, there’s someone else that doesn’t,’ Professor Jennings said.
 
‘So there is a case for better ascertaining it and being on the lookout for it, and general practice is the place.
 
‘I think using the opportunity when someone who’s in the target age range and background comes to see a GP, particularly those risk factors I talked about, will help to lower those death rates.’
 
Medication can also be extremely useful in the management of AF, when properly applied.
 
‘We know that not enough people who should be getting anticoagulants for AF are getting them,’ Professor Jennings said. ‘So it’s a matter of, if you do pick it up, whether it’s a paroxysm or whether it’s sustained, to then consult the guidelines and make sure that everybody the guidelines suggests should receive anticoagulants as a stroke prevention, do get it.’
 
The overall message that Professor Jennings wants GPs and older patients to receive is, make sure
you have regular appointments with your doctor, especially from the age of 65 and older.
 
‘It’s essential that older Australians with risk factors are aware of this condition and see their GP or health professional to get checked,’ Professor Jennings said.
 
‘The burden of this silent killer will keep increasing unless AF and its risk factors are prevented, detected and treated effectively.’

atrial fibrillation Cardiovascular disease Coronary disease heart disease heart failure heart health older patients stroke