The cardiovascular condition known as Atrial Fibrillation (AFib) is on the rise in the U.S.
The prevalence of cardiovascular disease is on the rise in the U.S., and statistics have shown the alarming trend that heart diseases could soon impact nearly half (48%) of American adults, according to the American Heart Association (AHA).
A particularly prevalent, debilitating cardiovascular disease, known as atrial fibrillation, or AFib, causes patients to experience a quivering or irregular heartbeat (arrhythmia). Sometimes the heart’s upper chambers quiver so quickly that the heart cannot relax between contractions. This functional abnormality reduces the heart’s performance and efficiency, leading to life-threatening symptoms for patients, according to The National Heart, Lung, and Blood Institute (NIH).
“AFib is an irregular heartbeat that, if left untreated, can lead to life-threatening complications such as blood clots, strokes, and heart failure. The disease can manifest itself differently in different patients,” said Mellanie True Hills, founder and CEO of StopAfib.org.
Currently, approximately 7 million Americans are living with atrial fibrillation, according to the NIH. The AHA estimates that over 12 million people are projected to have AFib by 2030. Each year in the U.S., AFib accounts for nearly 500,000 hospitalizations and almost 150,000 deaths.
AFib is generally an ongoing heart issue that persists for years. The disease tends to be progressive, going from paroxysmal (intermittent) to persistent (all the time) or longstanding persistent, (more than one year of being persistent). The disease often becomes persistent or continuous over time and is no longer episodic.
In patients with AFib, because the heart is quivering rather than pumping blood rhythmically, not enough blood gets pumped out of the atria (heart chamber) each time the heart beats. The blood, as a result, becomes stagnant and forms into clots. Blood clots can be extremely dangerous, as blood clots formed in the heart can be inadvertently pumped out of the heart to the patient’s brain, according to the NIH, blocking its blood supply and causing a variety of complications throughout the body.
Some patients may not notice the symptoms of the heart condition, known as asymptomatic AFib. The disease also may be much more difficult to diagnose if a patient comes into a physician’s office when the heart is beating at a normal speed. In these cases, patients don’t report anything amiss to their physician. As a result, AFib may not be caught or diagnosed unless a patient comes in for a different surgery or procedure. In other cases, the disease might be mistaken for something else.
“If the disease is persistent or longstanding persistent, it may be caught in a doctor’s visit,” said Hills. “However, if it is paroxysmal, it may not be. If the disease is asymptomatic, regardless of whether it is paroxysmal, persistent, or longstanding persistent, the person may not notice it or mention it to their doctor, and thus it may not get caught, especially if the person’s pulse is not checked during the appointment.”
AFib can result in serious health issues if not diagnosed and treated promptly. About 15% to 20% of people who have strokes in the U.S. have also been known to have AFib, according to the AHA.
Timely diagnosis and treatment
Timely diagnosis and treatment of AFib is very important to best assess a patient’s condition and make treatment decisions. However, due to a variety of factors, patients across the U.S. may not receive the same treatment for the life-threatening condition.
The impacts of AFib have been shown to vary substantially due to a patient’s race, ethnicity, sex, and social determinants of health, according to a report from StopAfib.org titled “Addressing Health Equity to Improve Atrial Fibrillation Patient Experiences and Outcomes.”
AFib is most common in men and White individuals. The estimated lifetime risk of AFib in White patients is 1 in 3, in women is 1 in 4, and in Black populations is 1 in 5, according to StopAfib.org.
“For the most up to date treatment of AFib, it may be important to see a specialist, such as an electrophysiologist; that is a cardiologist with several extra years of training to specialize in the electrical system of the heart,” said Hills. “However, accessing specialty care for certain groups of patients can be challenging due to lack of transportation, lack of time away from work, or a lack of means to access specialists for inner city or rural individuals.”
Research shows that gaps in care can result in negative health impacts for certain groups including women, Black and Hispanic patients, and other underrepresented racial and ethnic groups. Patients in these groups, according to the report, often do not receive guideline-recommended management that has been proven to improve outcomes and quality of life.
Symptom burden, quality of life, and clinical outcomes are documented to be worse in Black and Hispanic people and other underrepresented groups. The StopAfib.org report findings shed light on a critical need to address AFib disparities – including differences in health status between certain groups and inequities related to social, economic, environmental, or healthcare access related to the treatment of patients with the condition.
Although the prevalence of AFib is lower in White patients, women and patients in racial and ethnic minority groups may have longer lasting and more frequent symptomatic episodes of AFib, and worse quality of life overall, according to the StopAfib.org report. These patients may struggle with managing AFib, especially if they lack social or community support. Additionally, while Black and Hispanic individuals have a lower incidence of AFib than White individuals, these groups are shown to have a higher burden of comorbidities, including hypertension, cardiomyopathy, and diabetes, and a higher risk of adverse outcomes, such as stroke, heart failure, coronary heart disease (CHD), and death.
“Even if a patient does receive a diagnosis for AFib, medications, treatments, and procedures are expensive, and for some patients, can be entirely inaccessible because they cannot afford the cost of them,” said Hills. “Physicians can assist individuals on Medicare facing medication barriers by referring patients to a Medicare program called “Extra Help, ” a program that covers Medicare drug coverage (Part D) costs for people who have limited income and resources. Pharmaceutical companies also offer coupons
or vouchers that may reduce medication costs.”
Additionally, women have a higher risk for adverse outcomes associated with the disease, which includes a higher incidence of stroke (by a factor of 5.7, versus 4.0 in men), heart failure (by a factor of 11.0, versus 3.0 in men), and death (increased by a factor of 3.5, versus 2.4 for men), according to the StopAfib.org report.
“Once a person is diagnosed with AFib, some doctors may not understand the effect AFib has on the patient. For example, women tend to be more symptomatic, and doctors may not realize that women may need different, more personalized AFib treatment,” said Hills. “In many cases, doctors don’t recognize the way AFib can differ in its presentation in the individual, which can result in treatment disparities.”
More effective treatment
As medical research has advanced in recent years, researchers have learned more effective ways to treat AFib. The previous guidelines for AFib viewed rate control (medications that control heart rate) as being as effective, if not more so, as rhythm control (medications that control heart rhythm). More recent guidelines have shifted based on updated research. Guidelines now show that controlling both the heart’s rhythm and rate immediately after a patient is diagnosed often results in better health outcomes, according to Hills.
“Instead of requiring patients to try one rate control medication after another for their AFib, research has shown that initiating rhythm control early on can improve outcomes in patients,” said Hills. “This research showing improved outcomes from rhythm control allows physicians to use procedures earlier, soon after diagnosis.”
The treatment goals for atrial fibrillation start with a proper diagnosis by a physician, including an electrocardiogram (ECG), a type of heart test, and patient medical history. Generally, if AFib is not captured and confirmed on an ECG, a doctor will have a patient wear a heart monitor for up to a month to capture AFib patterns in the heart.
The ideal goals of AFib treatment, according to StopAfib.org, include four pillars: rate control (managing this reduces the risk of heart failure), rhythm control, stroke prevention, and risk factor management (lifestyle changes). Doctors also may recommend increased physical activity, eating a heart healthy diet, managing high blood pressure, avoiding alcohol, not smoking, and maintaining a healthy weight.
“StopAfib.org approaches spreading awareness about the disease by speaking at medical conferences to help doctors understand what the patient experience with AFib is,” said Hills. “Our organization also speaks about the resources that doctors can provide patients to help educate them and help patients better participate in shared decision making.
“We also speak to patients at our annual conference and through webinars. At our conference this year, the chair of the new guidelines committee, Dr. Jose Joglar, will speak about ‘What Patients Should Know About the New AFib Guidelines,’” said Hills.
According to the StopAfib.org report, poor access to care and lack of access to specialist physicians, screening, digital monitoring technology, and broadband internet may contribute to the underdiagnosis of AFib and reduced treatment options for patients. Similar factors and low socioeconomic status may also limit patient access to costly procedures and medicines. To address these disparities, the report recommends a strategy that addresses healthcare delivery, including improving healthcare provider awareness and knowledge of AFib care disparities and inequities. Other strategies include ensuring that clinical trials include a broad and representative range of patients by race, ethnicity, and gender.
Healthcare providers can also implement certain practices to help bridge AFib diagnosis and treatment gaps. These actions include improving community and patient education on AFib, such as encouraging at-risk patients to meet with their physician or to make lifestyle changes, changing the face of medical care, such as having more minority groups enter healthcare so that patients feel supported within physician offices, and including minority groups in clinical trials to get a better idea of how AFib impacts communities.
“It is important for patients to be able to access the right treatments for AFib at the right time,” said Hills. “The new guidelines allow patients to avoid developing further health complications such as heart failure, stroke, and more. From a patient’s perspective, it is critically important for doctors to understand the current guidelines and most up-to-date research so they can provide the best possible patient care.”