Rohit R. Arora, MD

Atrial fibrillation is the most common form of heart arrhythmia. The condition complicates other heart conditions, causes 15% to 20% of all ischemic strokes, confers a five-fold risk of suffering an ischemic stroke, and doubles the risk of death.

	Incidence, prevalence, and mortality rates for atrial fibrillation have been climbing for more than two decades due to the growing numbers of aging adults in the United States and the fact that incidence of the condition grows with increasing age. The median age at diagnosis is 66.8 years for men and 74.6 years for women. Results from a recent analysis indicate the prevalence of atrial fibrillation will increase from 5.2 million cases in 2010 to 12.1 million cases in 2030.

	Patients with atrial fibrillation use more healthcare services than those without the condition, and the cost of treating the condition represents a significant healthcare burden. Treatment costs have been estimated at $6.65 billion per year, including the direct and in-direct costs of hospitalization, physician care and medications. Nearly half of these costs were related to hospital inpatient stays, a burden that can heavily impact care facilities and healthcare providers.

	“Atrial fibrillation is costly and can become debilitating as it worsens, yet it does not share the same priority on the public health agenda that other chronic diseases have,” said Christy Ferguson, JD, research professor in the department of health policy, 

School of Public Health and Health Services at George Washington University

	Because hospitals and providers often assume the burden of repeated hospitalization and related care, it is critical that healthcare professionals identify patients at risk, educate them about managing the condition, and facilitate partnerships that help improve health, productivity, and quality of life.

 Atrial fibrillation confers a greatly increased risk of stroke, and patients might not be aware that strokes related to the condition are nearly twice as likely to be fatal as other strokes.

	When patients and caregivers understand these serious implications, they may be more willing to adopt recommendations for management. In a recent survey, 90% of physicians said that they believed their patients underestimated the impact an atrial fibrillation-related stroke would have on their lives.

	In addition, physicians reported that patient resistance to treatment was one of the top three barriers to treatment initiation. In the same survey, however, 93% of patients said that they would do whatever their physician recommended to reduce stroke risk.

Rate or rhythm control depends on patient

	Identifying teachable moments for patients and caregivers can help facilitate better acceptance of treatment recommendations. Therefore, begin the conversation about stroke risk and prevention at diagnosis, and reinforce it at subsequent patient visits.

 Up to one-third of patients may not be able to identify common stroke symptoms. If a stroke related to atrial fibrillation occurs, it is critical that patients and caregivers recognize the signs early and take action quickly. Mnemonics such as FAST provide an easy-to-remember set of criteria for patients:

 Face. Ask the person to smile. Does one side of the face droop?

 Arms. Ask the person to raise both arms. Does one arm drift downward?

 Speech. Ask the person to repeat a simple phrase. Is their speech slurred or strange?

 Time. If any of these signs are observed, call 911 immediately.

 Many patients may have a poor understanding of atrial fibrillation, and they may not fully understand why consistent anticoagulant treatment is necessary. They may be confused and frightened by their symptoms. Some of their symptoms may have been minimized in the past as related to anxiety or panic attacks. Patients may not retain information initially presented to them because they are overwhelmed at the time of diagnosis. Some may need a caregiver or family member present at an office visit to help explain the condition and plans for treatment.

	It is critical to recognize the individual educational needs of each patient and tailor messages and materials accordingly. Any information provided should be accurate and easy to understand. All staff members who interact with patients should be trained adequately so that a consistent message is delivered. Depending on the demographics of the practice, it may be necessary to consider literacy levels, access to print versus electronic materials, and appropriate languages for educational items.

 Inform patients that they can live a normal, healthy life with appropriate, ongoing medical care. Remind them of the importance of taking medications as directed. Patients should be encouraged to adopt lifestyle changes that support reduction of risk factors related to atrial fibrillation. These can include managing co-morbid conditions such as hyperthyroidism, hypertension, or hypercholesterolemia.

	Dietary and lifestyle recommendations might include:

 It is important for patients to understand the risk posed by atrial fibrillation, the treatment options available to them, the lifestyle changes required for successful treatment, and their overall therapeutic goals. One useful tool is the “Partnering in your Treatment Plan Sheet” from the American Heart Association (see Patient Education Resources).

 Atrial fibrillation is a chronic condition, and maintaining a continuum of care is critical to effective, efficient treatment.

	Clinical research has established seven defining characteristics of optimal continuity of care:

		contact between patient and healthcare providers,

		collaboration among healthcare providers in empowering the patient,

		communication between all providers involved in patient care,

		coordination of a multidisciplinary team, with clear definition of roles,

		contingency plans for addressing patient concerns outside of office hours,

		convenience of home monitoring or other plans for care, and

		consistency of recommendations from healthcare providers and adherence to clinical guidelines.

-Reviewed by Rohit R. Arora, MD, Chairman of Cardiology, The Chicago Medical School, Chief of Medicine (NCVA), 

Captain James A. Lovell Federal Health Care Center

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