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Heart and Stroke Foundation report reveals: Up to a quarter of a million Canadians with irregular heartbeat five times more likely to have a stroke – and twice as likely to die from one

OTTAWA, June 10, 2009 – According to the Heart and Stroke Foundation, 350,000 Canadians currently diagnosed with the most common type of heart arrhythmia  - atrial fibrillation (AF) - are at least five times more at risk to have a stroke and twice as likely to die from one.  More worrisome is that the vast majority may not be aware of their stroke risk.1  

”Complicating matters, many Canadians are not being properly treated for the condition in the first place,” says Dr. Paul Dorian, Heart and Stroke Foundation spokesperson and cardiologist.

“Up to 15 percent of strokes are caused by AF,” adds Dr. Dorian.  “In people over the age of 60, that number increases to about one-third of strokes.”

Atrial fibrillation (AF), a type of irregular heart rhythm known as an arrhythmia, can cause the heart to beat very fast, sometimes more than 150 beats per minute. While it is rare in people under 40, its prevalence increases with age.  After the age of 55, the incidence of AF doubles with each decade of life and with other risk factors for heart disease and stroke including high blood pressure, diabetes and underlying heart disease.

“Stroke places a tremendous burden on our society. When AF patients have a stroke, the impact becomes even more profound,” says Dr. Marco Di Buono, director of research, Heart and Stroke Foundation of Ontario. “These patients are reported to stay in hospital longer, have increased disability, and are more likely to have recurrent strokes.” 2/,3  

A WAKE-UP CALL

“The most important medical advance in the past decade is the effectiveness of blood thinners in managing AF and the risk of having a stroke,” says Dr. Dorian. “Yet, it is extremely disturbing that only a small percentage of at-risk patients are actually prescribed these life saving treatments.”

Most Canadians living with AF manage their condition by following a healthy lifestyle and taking prescribed medication. While warfarin is the most commonly prescribed medication for reducing stroke risk in the AF patient, its use in Canada by people age 65 and older with the condition remains below 50 per cent.The use of anticoagulants such as warfarin prevent clots from forming in the heart and travelling to the brain.

“Clinical guidelines are in place but there is a need for healthcare practitioners to be aware of the condition’s risks and put the treatment options into practice,” says Dr. Di Buono. “Further, people with AF should talk to their healthcare providers about their stroke risk and what they can do about it.”

According to the Heart and Stroke Foundation, a growing body of evidence suggests that AF patients can be better categorized based on their risk for developing stroke as a means of identifying the appropriate therapy. For example, the elderly, those with a previous stroke or TIA (mini stroke), and patients with high blood pressure, diabetes, or heart failure are all at greater risk of suffering from a stroke after being diagnosed with atrial fibrillation.

The CHADS2 Index is a simple tool used by many healthcare providers to determine stroke risk:

 

Risk Criteria

Points

C

Congestive heart failure

1

H

Hypertension (high blood pressure)

1

A

Age (greater than 75 years)

1

D

Diabetes

1

S

Stroke or transient ischemic attack (TIA)

2


How the CHADS2 Index works: one point is given for each risk condition (age, high blood pressure, diabetes, congestive heart failure). A previous stroke or TIA adds two points to a patients score. The greater the score, the greater the risk of developing stroke. A patient with a score of 0 would have an annual risk of stroke of about 1.9%. The patient with a score of 6 would have about 18% annual risk of stroke.

Bottom line - stroke is a medical emergency and we know the AF patient is at increased risk of stroke, says Dr. Dorian. “All Canadians, AF patients especially, should know how to recognize and react to stroke warning signs if needed.”

WHAT IS THE HEART AND STROKE FOUNDATION DOING?

The Heart and Stroke Foundation is concerned about the high incidence of stroke, its impact and economic burden, and has taken a number of steps to address this issue, including:

  • Leading the Canadian Stroke Strategy with the Canadian Stroke Network. This initiative is designed to provide all Canadians with the best stroke care possible, regardless of where they live, by 2010.
  • Calling for better surveillance data on stroke. Accurate, timely, accessible information is essential to health. Patients, providers, managers and governments need information to guide prevention, improve care, and support research. The Canadian Heart Health Strategy includes a recommendation to gather Canadian data on the prevalence and incidence of heart disease and stroke risk factors, diseases, and health inequalities in Canada.
  • Coauthoring the Canadian Best Practice recommendations for Stroke Care (published in CMAJ, December 2008). The Consensus Panel participants identified recommendations that if implemented immediately would have the greatest impact on stroke care in Canada. Anticoagulation in stroke patients with atrial fibrillation was identified as one of the top 10 priorities.
  • Working with the Canadian Stroke Network to organize the first national Canadian Stroke Congress in 2010 to address this and many other issues related to stroke prevention, treatment, and management.
  • Developed an informative section on atrial fibrillation on www.heartandstroke.ca/AF.

Heart and Stroke Foundation Recommendations

To people with atrial fibrillation: 

  • Learn more about AF and talk to your doctor.
  • Be your own advocate – know what to ask when speaking with your health care provider if you are an AF patient. Every AF patient should ask :
    • What is my stroke risk?
    • What treatment should I be receiving?
    • Tell your doctor how you’re feeling and what symptoms you may or may not be experiencing.
  • Make sure you take your medication as prescribed and that your blood pressure is measured on a regular basis.
  • Visit the Heart and Stroke Foundation’s website www.heartandstroke.ca/AF to find out more about atrial fibrillation.
  • Stroke is a medical emergency – if you experience any of the signs of stroke call 9-1-1 or your local emergency number. Signs include:

    Weakness - Sudden loss of strength or sudden numbness in the face, arm or leg, even if temporary.
    Trouble speaking - Sudden difficulty speaking or understanding or sudden confusion, even if temporary.
    Vision problems - Sudden trouble with vision, even if temporary.
    Headache - Sudden severe and unusual headache.
    Dizziness - Sudden loss of balance, especially with any of the above signs

To healthcare practitioners: 

  • Familiarize yourself with the Canadian Cardiovascular Guidelines and Stroke Best Practices document and know how to determine risk of stroke for patients with AF and how to diagnose the AF patient.
  • Update your knowledge of, and consider use of anticoagulants and anticoagulation therapy in AF patients.
  • Talk to your patients with atrial fibrillation about their stroke risks.

To Canadians: 

  • Healthy lifestyle changes that lower blood pressure, such as maintaining a normal weight and limiting salt intake and controlling diabetes, can help reduce the chances of developing atrial fibrillation.
  • If you have high blood pressure, you are at increased risk of developing AF and should be aware of the AF symptoms: irregular and fast heartbeat, heart palpitations or a rapid thumping in the chest, chest discomfort, chest pain or pressure, shortness of breath, particularly with exertion, or anxiety, fatigue, dizziness, sweating, nausea, lightheadedness or fainting.

Canadians can seek more information on atrial fibrillaltion and stroke on the Heart and Stroke Foundation’s website at www.heartandstroke.ca/AF.

The Heart and Stroke Foundation, a volunteer-based health charity, leads in eliminating heart disease and stroke and reducing their impact through the advancement of research and its application, the promotion of healthy living, and advocacy.

References:

1 AF AWARE Group survey 2009 - Slightly more than 4% of patients are aware of the increased stroke risk that ensues with AF, The survey included 75 patients per country in 11 countries (including Canada.)

2/3 Lin H, Wolf P, Kelly-Hayes M, et al. Stroke severity in atrial fibrillation: The Framingham Study. Stroke 1996;27:1760-4.; Jorgensen HS, Nakayama H., Reith J., Raaschou HO, Olsen TS. Acute stroke with atrial birillation. The Copenhagen Stroke Study, Stroke 1998:27:1765-9.

4 Humphries KH, Jackevisius C, Gong Y, Svensen L, Cox J, Tu JV, Laupacis A. Population rates of atrial fibrillation/flutter in Canada. Can J Cardiol 2004;20:869-76 .