The Importance of Atrial Fibrillation Burden

Atrial 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. This is viewed as a binary approach and has limited our understanding of the risks for AFib and its actual impact on patient outcomes. An ideal approach 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 Association (AHA) provides a more in-depth and comprehensive discussion on this topic. (1)

Scientific Statement on Afib Burden

The AHA 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. This is then expressed 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.

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. Little data exist, however, and a 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

Important for preventive cardiovascular nurses is the section on risk factor management programs and AFib burden. The review of studies suggests that a structured and comprehensive risk factor management program focused on the reduction of traditional atherosclerosis risk factors, with an emphasis on weight loss and maintenance of a healthy weight, effectively reduces AFib burden. Further research is needed into the effects exercise training, intensive blood pressure lowering, and stress reduction interventions have on risk factor reduction and AFib burden.

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

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