Essence of this Article
Atrial fibrillation (AF) is the most common cardiac arrhythmia seen in clinical practice, affecting more than 6 million people in the European Union (EU) and 3 million in the United States (US). It is primarily a condition of the elderly and, because of the ageing population worldwide, the prevalence of AF is predicted to double within 50 years. AF is a major risk factor for stroke, owing to the formation of thrombi in the heart that can embolize and travel to the brain, resulting in ischaemic stroke. Prevention of thromboembolism and stroke is an important goal in treating patients with AF. This can be achieved with the use of anticoagulants and less effectively with antiplatelet agents.
Atrial fibrillation-related stroke: a major healthcare burden
AF is primarily a condition of the elderly:
- Prevalence increases from 0.7% in those aged 55–59 years to almost 18% in those >85 years of age177
- The overall prevalence of AF is predicted to at least double in the next 50 years, as a consequence of the ageing population175
The atria of the hearts of patients with AF beat irregularly, and often rapidly.178 Diagnosis of AF is confirmed using an electrocardiography.
AF is a major risk factor for stroke:
- Thrombi form in the fibrillating left atrium of the heart in patients with AF – most commonly in a small pocket in the left atrium called the left atrial appendage
- These can embolize and travel to the brain, resulting in ischaemic stroke
- Consequently, patients with AF have an approximately fivefold increased risk of stroke179
- Strokes that occur in patients with AF are generally more severe and are associated with greater mortality and morbidity than those in patients without AF180
- Stroke in patients with AF results in longer hospital stays and greater healthcare resource use and costs for the healthcare system than in those without AF181, 182
The objectives of treating AF are to relieve symptoms (when present) and to optimize cardiac function. In addition to restoring heart rhythm or controlling heart rate, another goal of treatment is to minimize the risk of stroke by preventing thrombus formation in the heart.
A crucial part of AF management is the prevention of thromboembolism and AFrelated stroke, which can be achieved with the use of anticoagulants and less effectively with antiplatelet agents.