Addressing AFib in Clinical Practice

Why Worry About Atrial Fibrillation (AFib)?

Patients with or at risk for atrial fibrillation (AFib) are seen in virtually every practice setting. Early detection and effective, guideline-based treatments can reduce their risk of stroke or death. Addressing AFib in clinical practice includes strategies to identify those at risk and utilizing patient-centric treatments that include appropriate anticoagulation therapy.

  • AFib is the most common sustained cardiac arrhythmia in clinical practice, and it is associated with an increased risk for cardiovascular and cerebrovascular events and related deaths.[i]
  • In the US, it is estimated that at least 3 to 6 million people have AFib, and it is expected to reach up to 16 million people by 2050[ii] due to the aging population, increase in the prevalence of obesity, increased detection, and other factors
  • AFib is associated with a 1.5- to 2x increased risk for death.[iii],[iv]
  • The risk for stroke is increased 2.5- to 5-fold with AFib, and it causes up to 1 in 4 of all ischemic strokes across the globe.[v]
  • Additional health impacts of AFib include:
    • 1.5-fold risk of cognitive impairment or dementia[vi]
    • 1.5-fold risk of myocardial infarction (MI)[vii]
    • 2-fold risk of sudden cardiac death[viii]
    • 5-fold risk of heart failure (HF)[iv]
    • 1.6-fold risk of chronic kidney disease (CKD)[iv]
  • While awareness and diagnosis continue to improve, each year an estimated 500,000 individuals are undiagnosed.[ix]
  • AFib is associated with higher healthcare utilization and costs.[x]
  • 1.3-fold risk of peripheral artery disease (PAD)[iv]

Effective Diagnosis and Treatment

For at-risk patients with AFib, oral anticoagulation therapy (OAC) significantly reduces the risk for thromboembolism.[xi],[xii] Yet, up to 50% of those who are eligible for OAC do not receive them, and patients for whom OACs are prescribed often receive subtherapeutic doses.[xiii],[xiv],[xv]

Implementing current guideline recommendations includes effective diagnosis as well as implementing optimal treatments, using a shared decision-making framework to balance the risk for stroke and other health risks with potential risks for bleeding.

Insights into Advances in Nonvalvular AFib: Microlearning Library

PCNA has partnered with The France Foundation to produce a series of three complimentary micro-learning courses (all available for CE contact hours) to help clinicians learn about the current guideline recommendations and how to implement them into clinical practice.

Note: The 2023 ACC/AHA/ACCP/HRS guideline recommends that the terms ‘valvular atrial fibrillation’ and ‘nonvalvular atrial fibrillation’ be discontinued as they are potentially confusing.[xvi] In the activities below, ‘NVAF’ refers to AFib without a history of moderate to severe mitral stenosis or mechanical heart valve, for which DOACs are preferred for anticoagulation therapy when appropriate.

The three modules may be completed separately or sequentially to provide a comprehensive overview of addressing AFib in clinical practice.

Exploring Undiagnosed NVAF and its Comorbidities

  • Learning Objective: Summarize the prevalence and burden of undiagnosed NFAF
  • Faculty
    • Christian Ruff, MD, MPH
    • Laura VanBrocklin, DNP, FNP, RN-BC, FPCNA
    • Jennifer Walker, MSN, ANP-BC
  • 0.6 CE contact hours, including 0.2 CE pharmacology hours
  • Learning Objective: Identify patients at risk for NVAF through recommended and advanced screening tools
  • Faculty
    • Laura VanBrocklin, DNP, FNP, RN-BC, FPCNA
  • 0.4 CE contact hours

Creating Patient-centric Treatment Plans With Anticoagulation Therapy and Education

  • Learning objective: Recall strategies to develop patient-centric treatment plans that include appropriate anticoagulation therapy and patient education
  • Faculty:
    • Christian Ruff, MD, MPH
    • Laura VanBrocklin, DNP, FNP, RN-BC, FPCNA
    • Jennifer Walker, MSN, ANP-BC
  • 0.6 CE contact hours, including 0.6 CE pharmacology hours

[i] Michaud GF, Stevenson WG. Atrial fibrillation. N Engl J Med. 2021;384(4):353-361. https://pubmed.ncbi.nlm.nih.gov/33503344

[ii] Kornej J, Börschel CS, Benjamin EJ, Schnabe RB. Epidemiology of atrial fibrillation in the 21st century: novel methods and new insights. Circ Res. 2020;127(1):4-20. https://pubmed.ncbi.nlm.nih.gov/32716709

[iii] Emdin CA, Wong CX, Hsiao AJ, et al. Atrial fibrillation as risk factor for cardiovascular disease and death in women compared with men: systematic review and meta-analysis of cohort studies. BMJ. 2016; 532:h7013.

[iv] Odutayo A, Wong CX, Hsiao AJ, et al. Atrial fibrillation and risks of cardiovascular disease, renal disease, and death: systematic review and meta-analysis. BMJ. 2016; 354:i4482

[v] Barnes GD, Piazza G; Global Anticoagulation Roundtable Working Group. Barriers to stroke prevention in atrial fibrillation: insights from the Global Anticoagulation Roundtable. Int J Cardiol Heart Vasc. 2022;42:101096. https://pubmed.ncbi.nlm.nih.gov/35942005

[vi] Papanastasiou CA, Theochari CA, Zareifopoulos N, et al. Atrial fibrillation is associated with cognitive impairment, all-cause dementia, vascular dementia, and Alzheimer’s disease: a systematic review and meta-analysis.J Gen Intern Med. 2021; 36:3122–3135.

[vii] Ruddox V, Sandven I, Munkhaugen J, et al. Atrial fibrillation and the risk for myocardial infarction, all-cause mortality and heart failure: a systematic review and meta-analysis. Eur J Prev Cardiol. 2017; 24:1555–1566.

[viii] Rattanawong P, Upala S, Riangwiwat T, et al. Atrial fibrillation is associated with sudden cardiac death: a systematic review and meta-analysis. J Interv Card Electrophysiol. 2018; 51:91–104.

[ix] Turakhia MP, Guo JD, Keshishian A, et al. Contemporary prevalence estimates of undiagnosed and diagnosed atrial fibrillation in the United States. Clin Cardiol. 2023;46(5):484-493. https://pubmed.ncbi.nlm.nih.gov/36855960

[x] Tsao CW, Aday AW, Almarzooq ZI, et al. Heart disease and stroke statistics-2023 update: a report from the American Heart Association. Circulation. 2023;147:e93–e621

[xi] January CT, Wann LS, Calkins H, et al. 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society in Collaboration With the Society of Thoracic Surgeons. Circulation. 2019;140(2):e125-e151. https://pubmed.ncbi.nlm.nih.gov/30686041

[xii] Hindricks G, Potpara T, Dagres N, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J. 2021;42(5):373-498. https://pubmed.ncbi.nlm.nih.gov/32860505

[xiii] Hess PL, Mirro MJ, Diener H-C, et al. Addressing barriers to optimal oral anticoagulation use and persistence among patients with atrial fibrillation: proceedings, Washington, DC, December 3–4, 2012. Am Heart J. 2014;168(3):239-247.e1. https://pubmed.ncbi.nlm.nih.gov/25173533

[xiv] Johansson C, Hägg L, Johansson L, Jansson JH. Characterization of patients with atrial fibrillation not treated with oral anticoagulants. Scand J Prim Health Care. 2014;32(4):226-231. https://pubmed.ncbi.nlm.nih.gov/25464863

[xv] Barnes GD, Piazza G; Global Anticoagulation Roundtable Working Group. Barriers to stroke prevention in atrial fibrillation: insights from the Global Anticoagulation Roundtable. Int J Cardiol Heart Vasc. 2022;42:101096. https://pubmed.ncbi.nlm.nih.gov/35942005

[xvi] Joglar JA, Chung MK, Armbruster AL. 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2024;149:e1–e156. https://doi.org/10.1161/CIR.0000000000001193

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