We are in the midst of a silent epidemic. Failure to act now will result in a crisis that we cannot afford.
The epidemic results from atrial fibrillation (AF), a heart rhythm disorder that causes strokes. Strokes, in turn, cause death and disability. Stroke is the brain’s equivalent of a heart attack and it afflicts one person every five minutes in the UK1 and it is also a leading cause of adult disability.2,3
To prevent the tragic consequences of this epidemic it is essential that we target the prevention of stroke among the rapidly growing number of people who have AF.
Atrial fibrillation, the most common heart rhythm disorder, is less well known than stroke but it affects an estimated 1.5 million people in the UK. Aside from many other symptoms and consequences, people with AF become five times more likely to suffer a stroke.68 AF prevents blood flowing properly through the heart. This disruption allows clots to form. The most common and damaging type of stroke results from clots that have travelled to the brain where they cause a blockage in a blood vessel. Twenty percent of all strokes of this type of stroke result directly from AF. 4
Moreover, AF-related strokes are more severe and cause greater disability than strokes in patients without AF.4,5 Half of all AF patients will fail to survive more than 12 months following a stroke.4 For many sufferers, surviving a stroke can be worse than dying; as disability and fear of death become constant companions. AF and stroke not only devastate patients’ lives,6 but also the lives of their families and carers.7
Despite the availability of free and simple checks, authoritative estimates suggest around half of AF patients remain undetected. This is frequently because patients are unaware that the symptoms they experience are a sign of anything serious.8,10 Tragically, for many people a stroke is the first sign of underlying AF.
There remains an extremely low level of patient awareness of AF and stroke.9 Education is needed on the signs and symptoms of AF, on how AF is related to stroke, as well as on the risks they present both to life and health.
The current epidemic is predicted to worsen as the number of people with AF is expected to more than double by 2050.11,12 AF affects a greater proportion of older people than younger. Unless we take action, our ageing population will increase both the number of people with AF and the number of strokes that result from AF.13 This increase will also be amplified as we become better at preventing deaths from other conditions, such as heart attacks, which themselves increase the risk of AF developing.14
Properly used, existing treatments are effective and could prevent AF-related strokes, saving thousands of lives and millions from the National Health Service (NHS) budget.68 For example, when anticlotting therapy is used appropriately it is highly effective; lowering stroke risk by about two-thirds in AF patients.73
Yet, despite the existence of effective guidelines, vital anticlotting treatments are both underused and misused in clinical practice.15,16 This is largely due to perceived drawbacks16,5 associated with the most commonly used anticoagulant drug, warfarin.17,18 The impacts of warfarin on blood clotting need to be monitored not only to ensure that the drug is working, but also to ensure that the risk of excessive bleeding doesn’t become unacceptably high. The need for monitoring and the risk of bleeding appear to have a disproportionate impact on the use of effective anticlotting therapy that would otherwise save thousands of lives.
There is evidence that the above perceived drawbacks frequently overshadow current guidelines. This results in many doctors sticking with out-of-date treatment advice19,20,125,21 despite compelling evidence that following current guidelines dramatically reduces death and disability.
Today, many thousands of preventable strokes occur every year leading both to thousands of early deaths and a devastating burden on individuals, families and society. This burden takes many forms including disability, healthcare costs, social care as well as loss of working hours and tax revenues.
There is therefore an urgent need for coordinated action within the NHS to achieve earlier diagnosis and better management to reduce the risk of stroke in patients with AF. To address this need, the six actions called for by the AFA and ACE are:
- Targeted screening: The introduction of a targeted national screening programme drawing on routine manual pulse checks and ECG readings
- Guideline adherence: The development and adoption of policies that increase GP motivation to follow international guidelines
- Public awareness, patient empowerment: The use of existing materials to fuel a national public and patient education campaign to improve detection and patient empowerment
- Equity of treatment: The imposition of equal access to AF treatments and services for all patients using the NHS regardless of location
- GP education: An AF education campaign for GPs to illustrate the importance of symptomatic control, appropriate referral and the value of patient empowerment
- AF research: Government support for research into the causes, prevention and treatment of AF