Diagnosing atrial fibrillation (AF) could sharply reduce strokes in the United States, and primary-care physicians (PCP) have a key role to play, according to experts at the American College of Cardiology (ACC).
“Patients may often be asymptomatic,” explains Michael Ezekowitz, MD, vice president of clinical research at Main Line Hospitals in Pennsylvania. “They report no chest pain, no palpitations, no shortness of breath. They do feel fatigued, but they think that's just part of getting older. Unfortunately, they tend to present with unexplained stroke.”
About 2.2 million Americans have atrial fibrillation, which causes about one sixth of strokes in the United States. “These strokes tend to be more severe and disabling than strokes not associated with AF and are twice as likely to be fatal,” adds Donald T. Lackland, DPH, a professor of cardiology at the Medical University of South Carolina. “On the other hand, 60% of these strokes are potentially preventable by recognizing and treating AF.”
The two physicians presented an update on AF prevalence and treatment at the recent ACC scientific meeting in Orlando.
As the population ages, the number of AF cases is expected to rise, reaching 3.3 million by 2020 and nearly 5.8 million by 2050.
“PCPs must recognize the importance of AF,” Dr. Lackland urges. “They have more exposure to patients than cardiologists, so they need to do assessments” with ECGs or feeling the pulse to measure rhythms.
The next step is treatment. “Anti-coagulant therapy is much better than antiplatelet, but the therapy is difficult,” advises Dr. Ezekowitz. Part of the choice between anticoagulants and anti-platelets such as aspirin and clopidogrel is determined by other risk factors. “Anti-platelets may be used in low-risk patients or those with contraindications to oral anticoagulation, but they're not as effective,” he states.
He recommends the CHADS2 risk score (congestive heart failure, hypertension, age > 75, diabetes, and previous stroke) to determine therapy.