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The Importance of Atrial Fibrillation Burden

AFibAtrial fibrillation (AFib) is increasingly viewed as a public health problem due to its increased incidence, prevalence, and adverse impact on the growing aging population. Past studies of the burden of atrial fibrillation have focused on the presence or absence of AFib, which is viewed as a binary approach. This has limited our understanding of the risks for AFib and its actual impact on patient outcomes. Ideal approaches to defining burden would be enhanced by a comprehensive view of how the type (paroxysmal, persistent, or permanent), duration, and role of lifestyle and intensive risk factor modification influence AFib burden. A recent scientific statement from the American Heart Association1 provides a more in-depth and comprehensive discussion on this topic. 

The statement makes a case for defining AFib burden as the duration of the longest AFib episode or number of AFib episodes during a certain monitoring period and expressing that as a percentage.1 An excellent review of the literature and analysis of the most recent clinical trials of anticoagulation and antiplatelet agents, as well as an analysis of data from AFib registries, led to the conclusion that patients with persistent AFib are at highest risk for stroke than those with paroxysmal AFib. In addition to stroke risk, persistent AFib was noted to be associated with lower cognitive function when compared with persons having no AFib or paroxysmal AFib. However little data exists, and greater study of this relationship is required for more definitive conclusions. On the other hand, AFib has been associated with lower quality of life, yet few interventions have connected reduced AFib burden with better quality of life. This could be related to the multiple ways of measuring quality of life and the confusion on measuring AFib burden.

Important for preventive cardiovascular nurses is the section on risk factor management programs and AFib burden. The review of studies suggest that a structured and comprehensive risk factor management program focused on reduction of traditional atherosclerosis risk factors and emphasis on weight loss and maintenance of a healthy weight effectively reduces AFib burden. Areas for further research on the effect of risk factor reduction and AFib burden are necessary for exercise training, intensive blood pressure lowering, and stress reduction interventions. 

As new monitoring technology and approaches evolve, the ability to detect AFib episodes and ultimately burden will improve. Cardiovascular nurses have the opportunity to improve patient outcomes by reducing AFib burden with their preventive clinical approaches and innovative future research.

References:
  1. Chen, LY, Chung MK, Allen LA, Ezekowitz, M, Furie K.L. , McCabe, P., Noseworthy, P.A., Perez, M.V., Turakhia, M.P, on behalf of the American Heart Association Councils on clinical Cardiology, Cardiovascular and Stroke Nursing, Quality of Care and Outcomes Research, and Stroke. Atrial Fibrillation Burden: Moving Beyond Atrial Fibrillation as a Binary Entity, Circulation, 2018; 137: e623-644.