Atrial Fibrillation and Stroke Prevention - Take care of your heart early, put your mind at ease! - Living with AF
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
Take care of
your heart early,
put your mind
at ease!
Learn about AF and stroke early
to free your mind from worry.
Atrial Fibrillation and
Stroke Prevention
Atrial fibrillation
can increase the risk of
stroke by 5 times1
In Hong Kong, about one-fourth
of strokes are related to atrial fibrillation2
The number of AF-related strokes increased by
2.5 times between 1999 and 2014 2
Local and worldwide epidemiology
About 1–2% of the world’s population is affected by AF. As the
population ages, the incidence of AF is expected to double in the
next 50 years.3 In Hong Kong, around 7% of elderly aged 65 or
above have AF.4 In 2014, AF led to almost 45% of ischaemic strokes
and transient ischaemic attacks (TIAs) among patients aged 80
or above.2Understanding atrial fibrillation
Atrial fibrillation – also known as AF or Afib – is the most common type
of arrhythmia.1 Normally, the sinus node generates electrical impulses that
travel from the atria to the ventricles, causing the heart to contract and beat
at even and consistent intervals. In AF patients, the electrical impulses in
the upper chambers of the heart (the atria) are abnormal, causing irregular
and rapid heartbeats.5
An irregular heart rhythm may cause blood to pool and clot in the left
atrium. If a blood clot travels to the brain, it may cause a stroke.5 AF alone
can increase your chance of having a stroke by 5 times. Furthermore,
AF-related strokes are more severe than other types of stroke.1
Risk Factors5
• Increased age • Binge drinking
• Hypertension • Family history of AF
• Underlying heart disease – • Sleep apnea
including heart valve problems, • Chronic conditions – including
cardiomyopathy, coronary artery hyperthyroidism or other
disease, or a history of metabolic imbalances, lung
heart attack diseases or diabetes
Symptoms5
Some people with AF may not have any symptoms and are unaware of their
condition until they are diagnosed during a physical examination. Some signs
and symptoms of AF may include:
• Heart palpitations • Lightheadedness
• Weakness • Dizziness
• Reduced ability to exercise • Shortness of breath
• Fatigue • Chest pain
If you experience any of the above symptoms, please seek for medical help as
soon as possible.
Classification of AF4,5
Depending on the duration and nature of the arrhythmia, AF can be classified
into 3 types:
AF episodes that last a few minutes to hours, or up to a
Paroxysmal week. Symptoms may go away on their own or you may need
treatment.
AF episodes that last longer than 7 days. People will need
Persistent treatment such as an electric shock or medications to restore
their heart rhythm.
Paroxysmal and persistent AF may progress to become
Permanent permanent over time. Patients will need long-term medications
to control their heart rhythm and prevent blood clots.Stroke risk assessment for
AF patients
Current international guidelines recommend assessing stroke risk in AF
patients with CHA2DS2-VASc score. The higher the score, the greater the risk
of stroke.6,7
CHA2DS2-VASc score and adjusted annual stroke rate7:
CHA2DS2-VASc risk factors Score Total Adjusted stroke
score rate (% per year)
Congestive heart failure +1 0 0
Hypertension +1 1 1.3
Age ≥75 years +2 2 2.2
Diabetes mellitus +1 3 3.2
Stroke/TIA/TE +2 4 4.0
Vascular disease (prior MI, PAD, 5 6.7
+1
or aortic plaque)
6 9.8
Age 65–74 years +1
7 9.6
Sex category (female) +1
8 6.7
Maximum score 9 9 15.2
*CHA2DS2-VASc score is not applicable for patients with moderate-to-severe mitral stenosis or
mechanical heart valves
HAS-BLED score6,9
This is mainly used to assess the risk of bleeding in AF patients. Bleeding risk
can be lowered by addressing relevant risk factors.6,9
However, a high HAS-BLED score should not be a deciding factor for avoid-
ing or stopping anticoagulation therapy as stroke risk tracks along with
bleeding risk.9
Risk factors Score
Hypertension +1
Abnormal renal/liver function (1 point each) +1/+2
Stroke +1
Bleeding history +1
Labile INR +1
Elderly >65 years +1
Drugs/alcohol concomitantly (1 point each) +1/+2Understanding atrial fibrillation Stroke risk assessment for Treatment recommendations
Atrial fibrillation – also known as AF or Afib – is the most common type
of arrhythmia.1 Normally, the sinus node generates electrical impulses that
AF patients According to the European Society of Cardiology and American Heart Association guidelines, anticoagulants are recommended in male patients with a CHA2DS2-VASc
score of ≥2 and in female patients with a score of ≥3 to reduce the risk of AF-related stroke.6,8 Male patients with a CHA2DS2-VASc score of ≥1 and female patients with
travel from the atria to the ventricles, causing the heart to contract and beat Current international guidelines recommend assessing stroke risk in AF a score of ≥2 should consider taking an anticoagulant in order to reduce the risk of stroke.6,8
at even and consistent intervals. In AF patients, the electrical impulses in patients with CHA2DS2-VASc score. The higher the score, the greater the risk
of stroke.6,7 The guidelines also recommend non-vitamin K antagonist oral anticoagulants (NOAC) in preference over vitamin K antagonist (VKA).6,8
the upper chambers of the heart (the atria) are abnormal, causing irregular
and rapid heartbeats.5 CHA2DS2-VASc score and adjusted annual stroke rate7: Choosing an anticoagulant
An irregular heart rhythm may cause blood to pool and clot in the left Total Adjusted stroke
CHA2DS2-VASc risk factors Score Stroke is a major complication of AF, while taking an anticoagulant carries a risk of bleeding. As a result, striking a balance
atrium. If a blood clot travels to the brain, it may cause a stroke.5 AF alone score rate (% per year)
between efficacy in stroke prevention and bleeding risk is a major consideration.
can increase your chance of having a stroke by 5 times. Furthermore, Congestive heart failure +1 0 0
AF-related strokes are more severe than other types of stroke.1 Comparison between VKAs and NOACs in terms of efficacy in stroke prevention, risk of major bleeding and precautions:
Hypertension +1 1 1.3
Vitamin K antagonist (VKA) Non-vitamin K antagonist oral anticoagulant (NOAC)
Risk Factors5 Age ≥75 years +2 2 2.2
Reduces the risk of stroke by At least as effective as VKA, while certain NOACs are
Efficacy in stroke prevention around 64%10 significantly more effective6
• Increased age • Binge drinking Diabetes mellitus +1 3 3.2
• Hypertension • Family history of AF The risk of major bleeding of all NOACs are at least comparable, if not better than VKA,
Stroke/TIA/TE +2 4 4.0 Risk of major bleeding while certain NOACs have a significant lower risk6
• Underlying heart disease – • Sleep apnea Prevent Reduce
Risk of intracranial All NOACs have a significant lower risk of cerebral haemorrhage (including intracranial
including heart valve problems, • Chronic conditions – including Vascular disease (prior MI, PAD, 5 6.7 stroke bleeding risk
+1 haemorrhage haemorrhage) compared with VKAs6
cardiomyopathy, coronary artery hyperthyroidism or other or aortic plaque)
disease, or a history of 6 9.8 Risk of gastrointestinal Certain NOACs have a higher risk of gastrointestinal bleeding than VKAs, while some NOACs
metabolic imbalances, lung have a similar risk6
heart attack bleeding
diseases or diabetes Age 65–74 years +1
7 9.6
Drug–food interactions More food restrictions required11 Fewer, no specific food restrictions or interaction9
Sex category (female) +1
8 6.7
Symptoms5 Maximum score 9
Frequent blood test
monitoring
Required6 Not required6
9 15.2
Required, and dosing must be
Some people with AF may not have any symptoms and are unaware of their Frequent dose adjustments Not required12
*CHA2DS2-VASc score is not applicable for patients with moderate-to-severe mitral stenosis or controlled precisely11
condition until they are diagnosed during a physical examination. Some signs
mechanical heart valves
and symptoms of AF may include:
• Heart palpitations • Lightheadedness AF patients with chronic kidney disease may need to adjust The efficacy and safety profiles of VKAs and different NOACs
• Weakness • Dizziness HAS-BLED score6,9 the dosage of their anticoagulant based on the assessment of
kidney function or restrict the use of certain medications. To de-
vary from each other. It is important to consult your doctor
about their differences in stroke prevention and bleeding risk
• Reduced ability to exercise • Shortness of breath termine the appropriate anticoagulant and the correct dosing, to decide the most appropriate medication for you. Always take
This is mainly used to assess the risk of bleeding in AF patients. Bleeding risk
• Fatigue • Chest pain international guidelines recommended AF patients to attend medications as prescribed in order to reduce the risk of stroke.
can be lowered by addressing relevant risk factors.6,9
If you experience any of the above symptoms, please seek for medical help as regular check-ups and have their kidney function evaluated.6,9
soon as possible. However, a high HAS-BLED score should not be a deciding factor for avoid-
ing or stopping anticoagulation therapy as stroke risk tracks along with Distinguish between anticoagulants and antiplatelets
bleeding risk.9
Classification of AF 4,5
Both anticoagulants and antiplatelets can prevent blood clots from forming and are commonly prescribed to patients with different kinds of heart problems. Thus, they
Risk factors Score are often thought to be interchangeable, yet they work in completely different ways.13
Depending on the duration and nature of the arrhythmia, AF can be classified
into 3 types: Hypertension +1 Antiplatelets reduce blockages in blood vessels by interfering with platelet function. They are mostly used to treat coronary artery disease.13
AF episodes that last a few minutes to hours, or up to a
Abnormal renal/liver function (1 point each) +1/+2 According to the European Society of Cardiology, antiplatelet monotherapy is not recommended for stroke prevention in AF patients, regardless of stroke risk.6
Paroxysmal week. Symptoms may go away on their own or you may need
treatment. Anticoagulants vs. antiplatelets13
Stroke +1
AF episodes that last longer than 7 days. People will need
Persistent treatment such as an electric shock or medications to restore Bleeding history +1 Mechanism of action Recommended usage
their heart rhythm. Anticoagulants Interfere with clotting factors in the coagulation process to slow Reduce the risk of stroke and blood clot formation in AF patients. For the treatment
Labile INR +1
Paroxysmal and persistent AF may progress to become (blood thinners) down the formation of blood clots and prevention of deep vein thrombosis or pulmonary embolism.
Permanent permanent over time. Patients will need long-term medications Elderly >65 years +1 Antiplatelets Reduce blockages in blood vessels by decreasing platelet For the prevention of myocardial infarction (coronary artery disease) and ischemic
to control their heart rhythm and prevent blood clots. aggregation and inhibiting blood clot formation stroke, and for patients who have undergone coronary angioplasty or have other
Drugs/alcohol concomitantly (1 point each) +1/+2 cardiovascular diseasesTips to prevent AF5
Maintaining a healthy lifestyle helps improve your
heart health. It may also reduce your risk of AF.
Start with these steps:
Maintain a Limit or avoid
heart-healthy diet caffeine and alcohol
Exercise regularly – Relieve stress –
Consult your doctor Intense stress and
on the recommended anger can trigger heart
exercise intensity rhythm problems
before you start
to exercise
Use over-the-counter
Maintain a
medications such as cold
healthy weight
and cough medicines
with caution, as some of
them may trigger a
rapid heartbeat
Quit smoking
Pfizer Corporation Hong Kong Limited
18/F, Kerry Centre, 683 King’s Road, Quarry Bay, Hong Kong
Tel: 2811 9711
Website: www.pfizer.com.hk
PP-ELI-HKG-0520 MAR 2021AF, atrial fibrillation; INR, international normalized ratio; MI, myocardial infarction; NOAC, non-vitamin K antagonist oral anticoagulant; PAD, peripheral artery disease; TE, systemic thromboembolism; TIA, transient ischemic attack; VKA, vitamin K antagonist. References 1. Centers for Disease Control and Prevention. Atrial fibrillation fact sheet. Available at: www.cdc.gov/ dhdsp/data_statistics/fact_sheets/fs_atrial_fibrillation.htm. Accessed November 2020. 2. Soo Y, et la. J Neurol Neurosurg Psychiatry 2017; 88:744-748. 3. Molteni M, et al. Europace 2014; 16:1720-1725 4. Centre for Health Protection. Non-communicable diseases watch August 2016 – atrial fibrillation. Available at: www.chp.gov.hk/files/pdf/ncd_watch_aug2016.pdf. Accessed November 2020. 5. Mayo Clinic. Atrial fibrillation: Symptoms & causes. Available at: www.mayoclinic.org/diseases-conditions/ atrial-fibrillation/symptoms-causes/syc-20350624. Accessed November 2020. 6. Kirchhof P, et al. Eur Heart J 2016; 37:2893-2962. 7. January CT, et al. Circulation 2014; 130:2071-2104. 8. January CT, et al. Circulation 2019; 140:e125-e151. 9. Steffel J, et al. Eur Heart J 2018; 39:1330-1393. 10. Hart RG, et al. Ann Intern Med 2007;146:857-67. 11. MedlinePlus. Warfarin. Available at: https://medlineplus. gov/druginfo/meds/a682277.html. Accessed November 2020. 12. Weitz JI, et al. 2012;2012:536-540. 13. Drug Office. Oral Anticoagulants and Antiplatelet Drugs. Available at: https://www.drugoffice.gov.hk/ eps/do/en/consumer/news_informations/dm_25.html. Accessed January 2021.
You can also read
