AF-related stroke will always be a concern

Trudie Lobban MBE

Founder and CEO, Arrhythmia Alliance and AF Association

Atrial fibrillation (AF) can be a “silent killer” — often people with AF do not have symptoms and, therefore, are unaware that they are at risk of a devastating, and potentially fatal, stroke.

Without the right anticoagulation therapies, a person with AF is five times more likely to have an AF-related stroke than someone without AF. AF-related strokes are more devastating, more disabling, and more often, prove to be fatal than other types of stroke. We need to detect AF with a simple pulse check to protect against AF-related stroke. It could save your life.

The AF Association’s new AF White Paper — Put People First highlights that direct oral anticoagulants (DOACs) are now “firmly established” as the first-line anticoagulant therapy over and above warfarin.

Several studies suggest that DOACs are safer and more effective than warfarin and, unlike warfarin, DOACs do not require regular blood tests to ensure that a person is sufficiently anticoagulated.  

While there are no substantial differences between the different types of DOACs (four are available in the UK), they do differ in terms of their dosing regimens. 

Finding the best therapy for the individual

The AF white paper advocates that healthcare professionals review a patient’s individual needs and wishes, ensuring that they are prescribed a therapy that best suits the individual. It also notes that good communication between both the patient and healthcare professionals is vital to better understand the condition and adhering to the therapy regimen.

As with all medication, DOACs are only effective if they are actually taken as prescribed. They will not protect against AF-related stroke if they remain in the packet! 

Without the right anticoagulation therapies, a person with AF is five times more likely to have an AF-related stroke than someone without AF.

Heart rhythm check at vaccine sites

Obviously, you can only protect against AF-related stroke if you are able to detect AF in the first place. Unfortunately, COVID-19 restrictions — while necessary — have meant opportunities to detect AF, both in healthcare and non-healthcare settings, have been lost.

For example, over the last year, people have delayed or even avoided seeing their doctor because of concerns regarding COVID-19.

To address these lost opportunities, we are rolling out a scheme of opportunistic pulse rhythm checks at COVID-19 vaccine centres. The pulse rhythm checks are performed either manually or with mobile digital ECG technologies, which can be sanitised between uses (making them COVID-19 safe) and do not interfere or delay the vaccine process.

Anyone found to have an irregular rhythm, or “possible AF”, is referred to their GP for further investigation. All participants are also given information and advice about AF and the need to protect against AF-related stroke.