A number of risk factors are associated with stroke which, as we know, is a major problem in the UK – it’s the fourth most common cause of death, and a leading cause of major disability.
High blood pressure is recognised as one of the biggest single risk factors for stroke – which is why there have been so many campaigns highlighting the importance of watching our salt intake (since salt’s a big cause of hypertension) – but another possible risk factor is atrial fibrillation (AF).
While it’s not the most common cause of stroke, strokes associated with AF tend to be very major. The good news is, modern treatments can massively reduce the chances of somebody with AF suffering with a stroke – but figures suggest lots of people still aren’t benefiting from the recommended treatments. To address this, a new campaign called AF180 Degrees has just been launched.
Initiated by a number of experts and patient groups, including AF Association, AntiCoagulation Europe and the Arrhythmia Alliance, the aim is to ensure all AF patients are benefiting from the best treatments.
What is atrial fibrillation?
AF is characterised by an irregular and very rapid heartbeat. It’s one of the most common forms of abnormal heart rhythm and mostly occurs in older age groups, and those with other existing problems like type 2 diabetes, cardiovascular disease and high blood pressure, as well as a history of alcohol abuse and certain thyroid disorders.
Some people will be aware of an abnormal heartbeat and may have palpitations, breathlessness and dizziness, but it doesn’t always cause symptoms.
The Arrhythmia Alliance ‘Know Your Pulse’ campaign encourages people to learn how to take their own pulse, and see their GP if they suspect any symptoms. If AF is suspected, an ECG can be carried out to detect whether there’s an abnormal heart rhythm.
Is the stroke risk really a concern?
As Professor Martin Cowie, honorary consultant cardiologist at the Royal Brompton and Harefield NHS Foundation Trust, points out, while diet and lifestyle changes (being active, a healthy weight, not smoking etc) are known to help reduce the overall risk of suffering a stroke, for patients with AF, the AF-associated stroke risk can not be controlled by lifestyle changes alone, which is why it’s so vital that patients are aware of the link and advised to take appropriate medication.
AF is associated with a five-fold increased risk of stroke: figures suggest that every few hours, 10 people in the UK with AF will have a stroke.
They tend to be major strokes too. “AF strokes are caused by a clot in the heart, which breaks off, shoots up to the brain and blocks off a large section,” explains Cowie. “It’s usually a majorly debilitating stroke, and lots of [people who’ve had an AF-associated stroke] die within 30 days, and others left very disabled because it’s so devastating.”
How can AF patients reduce their stroke risk?
NICE (the National Institute for Health and Care Excellence) issued new guidelines on managing AF two years ago, recommending modern anticoagulants (blood-thinning drugs), rather than simply aspirin, in order to slash the risk of AF-related stroke. But Cowie notes it’s still a “bit of a postcode lottery”.
It’s believed that over 260,000 people with AF are not being treated in alignment with the new guidelines, for a number of reasons.
Cowie notes that some patients may simply not have received advice about the new guidelines, some might not be fully aware of their increased risk of stroke, and some might be cautious of taking anticoagulants because of all the negative side-effects they’ve heard about.
Others might still be taking aspirin as a sole treatment, though this is no longer recommended for stroke prevention with AF, and he thinks GPs should be “more pushy” in terms of explaining the pros and cons properly to their patients.
He stresses that modern anticoagulants have come a long way, and patients should sit down with their doctors to discuss their risk of stroke (there’s now a very simple scoring system that will give a straightforward assessment of somebody’s increased risk of stroke) and how they can best manage this.
“For the majority of cases, people with AF can reduce their stroke risk by about 70%,” Cowie notes. “The important thing is, GPs and patients need to be having these discussions.”
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