Atrial Fibrillation, Atrial Fibrillation Treatment, Stroke Prevention
Atrial fibrillation (AF) is the most common arrhythmia seen in clinical practice. An estimated 2.2 million people in the US and 4.5 million in the EU have AF.193 AF can be intermittent or persistent.43 Symptoms include palpitations, chest pain, fatigue, dyspnoea, lightheadedness, and syncope.370, 371 Cardiovascular causes of AF include hypertension, coronary artery disease, valvular heart disease, pericarditis, and pulmonary embolism.193, 371
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People with AF have an irregular heart rate that may be rapid.43 The diagnosis is confirmed by electrocardiography. Once the diagnosis is established, medical management involves identifying and addressing the cause of the AF and, when possible, restoring a normal cardiac rhythm.43, 370 When restoration of a normal heart rhythm is not feasible, the main goals of atrial fibrillation treatment include controlling the heart rate and minimising the risk of stroke by preventing thrombus formation in the heart.
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There is widespread underutilisation of anticoagulant therapy in stroke prevention for patients with AF. The reasons are multifactorial. Some patients refuse treatment because of the inconvenience of treatment with VKAs, which require frequent blood tests to monitor therapy and dosage adjustments, as well as food restrictions. Others may choose to forgo treatment because their fear of bleeding complications may outweigh their perception of likely benefits. Improved physician-patient communication may be required to ensure that all patients are educated adequately about the risk/benefit ratio of anticoagulation in AF.43 In addition, novel approaches to anticoagulant therapy may one day alleviate some of the issues and challenges associated with VKA use.
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See also: Acute Coronary Syndrome
See also: Embolism Pulmonary Sign