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Combatting the Burden of Atrial Fibrillation

An Interview with Trudie Lobban MBE, FRCP Edin, Founder and CEO, Arrhythmia Alliance and AF Association

Written by James Coker  Reporter, European Medical Group  @EMJJamesCoker

Atrial Fibrillation (AF) is the most common arrhythmia (irregular heart rhythm disorder), which is having a huge and increasing burden on patients, caregivers, and healthcare systems alike across Europe. In addition to being debilitating, it can also cause AF-related stroke, an especially devastating form of stroke, often proving fatal. Despite its impact, there is a surprising lack of awareness of the condition among the various stakeholders, including healthcare professionals and governments. A report published in November 2018 by Biosense Webster EMEA, a Division of Johnson & Johnson Medical NV/SA, entitled ‘The Burden of Atrial Fibrillation: Understanding the Impact of the New Millennium Epidemic Across Europe’, has laid bare the scale of the problems caused by AF and emphasises why urgent action is now needed to tackle the disease. As part of our analysis of this report, we spoke to Trudie Lobban MBE, Founder and CEO of the charities Arrhythmia Alliance and AF Association to discuss its implications and the strategies needed for dealing with this growing burden.

Epidemic Proportions

The Biosense Webster report has highlighted how the extent of AF around the world is of epidemic proportions. Not only do the 11 million people believed to have the condition have major impairments to their quality of life, but the economic cost is huge, with the new publication calculating that AF costs healthcare systems up to €3,286 million annually across European countries. Future projections displayed in the report are cause for even greater concern. By 2030, the number of people with AF is projected to increase by up to 70%, and by the same year, 3.5–4 million hospitalisations for AF are expected.

This is not a situation that should be occurring according Lobban. “One in 4 of us over the age of 40 will develop AF. That is 25% of the over 40 population: a devastating statistic. We can and must do something about it,” she stated. “AF is a huge financial burden to healthcare systems worldwide, but it needn’t be. There are lots of conditions which are hugely expensive to treat, but with AF with relatively inexpensive therapies, people can ensure they reduce their risk of an AF-related stroke and also receive appropriate treatment to help restore them from a patient back to living their daily life as an active member of society.

Increasing Awareness

Whilst Lobban has observed greater awareness of the condition amongst stakeholders, she believes there remains significant room for improvement, with arrhythmias traditionally failing to receive the attention that other heart diseases do. There has certainly been a much greater emphasis on anticoagulant therapy in recent years, with a much higher number of anticoagulants available on the market in recent years than before. While this is a welcome development, Lobban highlights that anticoagulation helps reduce the risk of AF-related stroke however, it does not treat AF and she believes that the report highlights the importance of utilising treatment options more often. “There’s been a massive emphasis on AF and AF-related stroke, which was much needed and is why AF has worked its way up the agenda. But it’s stopping at anticoagulation therapy and reduction of AF-related stroke. We must also focus on treatment options to ensure patients have access to the most appropriate treatment to suit them. It’s like putting a sticky plaster on something: it’s not dealing with the underlying problem, and that’s why we Detect, Protect, Correct,” she commented. “I stress this to the hundreds of thousands of patients we hear from each year: you must get anticoagulated, but you must also ask what treatment options are available to you, be that drugs or surgical ablation. Studies have shown that the quicker you can have access to catheter ablation once you’ve been diagnosed with AF, the greater chance there is of completely curing AF.”

The next step is to make patients aware of the various options available, as well as ensuring they are readily accessible. Lobban added: “The treatments exist but millions of patients are not getting access to them. And to be fair to healthcare professionals, a lot of primary care GPs are not aware of all the treatment options such as ablation because it’s not readily available in many areas; therefore, it would not necessarily cross their mind, they might not even know about referring a patient for ablation.”

Know Your Pulse

To help ensure AF is detected early and therefore therapy more likely to be successful, Arrhythmia Alliance & AF Association advocate a campaign called ‘Know Your Pulse’. This encourages everyone to become aware of their heart rhythm and to manually check it everyday, an irregular heart rhythm is a possible indicator of AF. Additionally, modern technologies and applications help people to be aware of the rhythm of their heart. “Everybody should ideally take their pulse daily to get used to the rhythm of their heart so that when it becomes irregular, they’re aware of it and then go to their doctor,” said Lobban. She recalled a story from when she visited a school in Uruguay, where a 9-year-old child, after hearing about the importance of knowing your pulse to know your heart rhythm, was able to detect an irregular rhythm in her father, which led him to being later diagnosed with AF. With this in mind, the phrase used by the Arrhythmia Alliance to emphasise the whole approach to successfully combatting AF is ‘Detect, Protect, Correct’. Detect AF through a simple pulse check, Protect against AF-related stroke with anticoagulation therapy, Correct the irregular heart rhythm with access to appropriate treatment.

Need for Action

The symptoms of AF can often have a devastating impact on lives of those with the condition, even without taking into account its potential to cause AF-related stroke. Physically, it can be debilitating, causing breathlessness and tiredness in addition to mental health problems that commonly occur, such as anxiety and depression. This human side of the story alongside the economic impact highlighted by the report emphasise the need for urgent action amongst stakeholders. “For over 20 years Biosense Webster has pioneered the development of AF ablation treatments and through partnering with clinicians, have been able to heal the hearts of thousands of patients,” said Gabriele Fischetto, Vice President of Johnson & Johnson Cardiovascular Specialty Solutions in EMEA. “However, AF is becoming increasingly prevalent and we need urgent focus to understand the true burden of the disease, so we can work together to tackle it head on.”

To access the report by Biosense Webster EMEA, click here.

For further information on the know your pulse campaign, click here.