Monday, April 11, 2016

Many with Irregular Heartbeat Missing Out on Stroke-Preventing Treatments

Doctors know that a heart rhythm disorder called atrial fibrillation increases the odds for stroke. But less than half of “a-fib” patients at highest risk for stroke are prescribed recommended blood thinners by their cardiologists, new research finds.

“The findings of our study are surprising given that these patients with atrial fibrillation were treated by a cardiovascular specialist, who should be aware of guideline recommendations” for anticoagulants, such as warfarin, said study lead author Dr. Jonathan Hau. He is a cardiologist and assistant professor of medicine at the University of California, San Diego.

Hau’s team tracked more than 400,000 atrial fibrillation patients in the United States for four years. The investigators found that most were prescribed blood-thinning drugs up to a point. But more than 50% of the very highest-risk patients leave their doctor’s office without a prescription for potentially life-saving blood thinners.

Whether their doctors are ignoring or misinterpreting treatment guidelines isn’t clear, he said. “As with many issues in medicine, there are likely several reasons,” Hau suggested.

Part of the problem could simply be “patient preference,” he said. On the other hand, cardiologists may place too much emphasis on the risk for bleeding that blood thinners pose. But for most patients the benefits are worth the risk.

The study findings are published in the March 16 online edition of JAMA Cardiology.

Atrial fibrillation – characterized by electrical irregularities that prompt the upper chambers of the heart to function abnormally – can boost he risk for blood clotting and stroke fivefold, experts say.

One-quarter of all Americans over age 40 are at risk for developing atrial fibrillation at some point in their lives, the study authors noted.

In addition to warfarin (Coumadin), prescribed blood thinners in the United States include Pradaxa (dabigatrian), Xarello (rivaroxaban) and Eliquis (apixaban).

My Take:
Atrial fibrillation (a-fib) is a lifestyle issue, not a disease to be treated with medication or ablation. It is a symptom that the body’s metabolism is out of sync. Although some cardiologists have published papers supporting this concept, that’s not why they withhold prescribing blood thinners. I believe many cardiologists understand the long term negative effects of warfarin. They are not convinced that the drugs reduce the risk of stroke enough to warrant the risks of taking the drug. And based on the standards of care, once you place a patient on any of these drugs, they will be on them until they die.

The Bottom Line:
If you suffer from a-fib consider a complete evaluation of your lifestyle – diet, exercise habits, quality of sleep, and stress levels. The goal is to correct the condition rather than medicate the potential risk for stroke.

March 16, 2016 National Institutes of Health

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