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Jan 09, 2018

AFib Treatment Changes Over Time as Stroke Risk Increases

Patients with an irregular heart rhythm should revisit treatment options regularly, study suggests.

Patients with an irregular heart rhythm should revisit treatment options every few years, based on a recent study of more than 31,000 Taiwanese patients with atrial fibrillation.

A study recently published in the Journal of the American College of Cardiology has looked at changes in stroke risk among patients with atrial fibrillation, often referred to as AFib. AFib is the most common type of abnormal rhythm, which currently affects as many as 6.1 million Americans. AFib drastically increases risk for stroke—a leading cause of death in the United States. Blood thinners are recommended for patients with increased cardiovascular risk, such as those with diabetes and high blood pressure.

But as recent findings show, just because a patient is low-risk now doesn’t mean that they won’t need more aggressive treatment as their risk increases.

The recent study analyzed data from 31,039 Taiwanese adults who all had atrial fibrillation but low cardiovascular risk. Cardiovascular risk was measured by the CHA2DS2-VASc risk score, which takes into account factors like heart failure, high blood pressure, diabetes and past heart events. Risk scores range from 0 to 6, and the higher the score, the greater a patient’s risk for stroke.

Participants were then followed for 20 years, tracking key outcomes like stroke and death.

Upon enrollment, the average risk score among patients was 1.29, indicating a low risk for stroke. But after following participants for up to 20 years, the average risk score increased to 2.31, and 4,103 patients experienced a stroke.

By the end of the study, 64% of patients had developed at least one new cardiovascular risk factor and the majority of patients had an increase in their risk score. Researchers also found that patients with increased risk scores were more likely to experience stroke than those whose risk remained stable.

The take-home message, according to authors, is that stroke risk changes more often than not in patients with atrial fibrillation. Since most patients experience an increase in stroke risk over time, it’s important to revisit both cardiovascular risk and treatment options regularly. Authors hope that with closer monitoring, more patients can adjust their treatment accordingly to prevent heart events and improve outcomes.

Questions for You to Consider

  • What is atrial fibrillation?

  • Atrial fibrillation is an irregular heart rhythm caused by abnormal, chaotic electrical impulses in the heart’s upper chambers, the atria. These electrical impulses, which interfere with the heart’s natural pacemaker, fire so rapidly the atria cannot beat with a regular rhythm or squeeze out blood effectively. Instead, they merely quiver while the ventricles, the heart’s lower chambers, beat rapidly.
  • Why is someone with atrial fibrillation at risk for a stroke?

  • Normally, blood is constantly flowing through the atria, ventricles and blood vessels. But because blood pools in the quivering atria, it has the chance to congeal into blood clots, which can travel to the brain, blocking blood flow and causing a stroke. That’s why patients with atrial fibrillation must take some form of anti-clotting medication such as aspirin or the blood thinner warfarin (Coumadin).

    Not wanting to take lifelong blood thinners is one of the reasons people have radiofrequency ablation to rid themselves of atrial fibrillation. However, researchers in the new study advised anyone who has already had a stroke to continue taking blood thinners, since atrial fibrillation can return even after a successful radiofrequency ablation procedure.

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