Stroke in patients with non-valvular AF: a huge clinical challenge inadequately met
(AF) presents physicians with considerable clinical challenges in managing individual patients and places a huge burden on healthcare systems.
- AF is the most common sustained cardiac arrhythmia.70 AF affects 1–2% of the general population (more than 6 million cases in Europe alone) and the prevalence is expected to at least double over the next 50 years70
- AF is associated with increased rates of death, stroke and other thromboembolic events, heart failure, left ventricular dysfunction and hospitalization. Patients with AF can also experience reduced quality of life and exercise capacity70
- Strokes associated with AF have a more severe impact on patients compared with other types of stroke:
- In the year after an AF-related stroke, nearly 50% of patients die71
- More than 50% of patients who have an AF-related stroke suffer a degree of disability as a result72
- Vitamin K antagonists (VKAs), such as warfarin and acenocoumarol, are effective in reducing the risk of stroke but have practical limitations that lead to suboptimal patient adherence. These limitations include a need for regular coagulation monitoring and dose adjustment, multiple drug–drug interactions and dietary restrictions30
- As a result of these management challenges, as well as a fear of bleeding, many patients with non-valvular AF receive inadequate or no anticoagulation and remain at considerable risk of stroke73
- 70 - Camm AJ, Kirchhof P, Lip GY et al. Guidelines for the management of atrial fibrillation: The Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J 2010;31:2369–2429.
- 71 - Marini C, De Santis F, Sacco S et al. Contribution of atrial fibrillation to incidence and outcome of ischemic stroke: results from a population-based study. Stroke 2005;36:1115–1119.
- 72 - Gladstone DJ, Bui E, Fang J et al. Potentially preventable strokes in high-risk patients with atrial fibrillation who are not adequately anticoagulated. Stroke 2009;40:235–240.
- 30 - Ansell J, Hirsh J, Hylek E, Jacobson A, Crowther M, Palareti G. Pharmacology and management of the vitamin K antagonists: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest. 2008;133(6 suppl):160S-198S.
- 73 - Verheugt FW. Novel oral anticoagulants to prevent stroke in atrial fibrillation. Nat Rev Cardiol 2010;7:149–154.
- Atrial fibrillation
- A heart rhythm disorder where chambers in the upper heart (atria) beat more rapidly than those in the lower section of the heart. Blood is not pumped out of the upper chambers completely during beating, and may pool and form a clot. A stroke results if a section of clot dislodges from the upper chambers and becomes lodged in the brain.