Two new reports co-authored by Peter Kowey, MD, world-renowned cardiologist at Lankenau Medical Center and the William Wikoff Smith Chair in Cardiovascular Research at Lankenau Institute for Medical Research, both part of Main Line Health, examined strategies and appropriate technologies to undertake screenings that could identify patients at high risk for stroke. In the United States, approximately 795,000 people each year suffer a stroke, of which about 130,000 die. Those who survive are often left permanently disabled; in fact, stroke is the leading cause of serious long-term disability, according to the U.S. Centers for Disease Control and Prevention (CDC).
About 87 percent of all strokes are classified as ischemic strokes, in which blood flow to the brain is blocked. Atrial fibrillation (AF), a type of irregular heartbeat, markedly increases one’s risk for stroke, and as such, it is considered a risk marker and a risk factor for stroke. And yet worldwide, about 10 percent of patients who suffer an ischemic stroke associated with AF are first diagnosed with AF at the untimely incidence of their first stroke. That is, the patient and the health care worker were previously unaware of the stroke victim’s AF status. Even when diagnosed, less than half of eligible patients are treated with anticoagulants that have a dramatic and powerful effect to reduce stroke occurrence, studies show.
“Detecting asymptomatic AF early could provide a chance for health care professionals to save patients from a devastating stroke,” said Dr. Kowey. “If physicians are aware of patients’ AF, they could provide anticoagulation therapies, as well as suggest lifestyle changes that could significantly reduce the risk of a life-changing or life-ending stroke event.”
AF-SCREEN International Collaboration
Dr. Kowey is a participant in the AF-SCREEN International Collaboration, a group of 60 heart care experts from around the world who drafted a recently released report advocating for markedly increased screenings for AF, especially among patients 65 years and older. Approximately three-quarters of all strokes occur in this age group, studies show.
Besides age and AF status, other risk factors for stroke include high blood pressure, high cholesterol, and smoking. Additionally, the risk of having a first stroke is nearly twice as high for African Americans than Caucasians, and African Americans are also more likely to die following a stroke, according to the CDC. Hispanics’ risk for stroke falls in between that of Caucasians and African Americans.
The AF-SCREEN International Collaboration’s comprehensive report, published in a recent edition of the medical journal Circulation, includes six key points for health care workers. It outlines the ideal methods and technologies for accurate AF screening depending on the patient’s demographics and health status, and appropriate settings in which to conduct mass screenings, such as in community- and physician-based venues. The authors concluded: “Irregularity of the pulse is a simple way to screen for AF, but pulse palpation is seldom done in routine practice, and inexpensive screening devices are available.”
REVEAL AF study
The AF-SCREEN report was published the same week Dr. Kowey and his collaborators presented new data at the Heart Rhythm Scientific Sessions in Chicago. In that second study, called REVEAL AF, his team showed that continuous monitoring of an at-risk—but previously undiagnosed high-risk—population with a miniature implantable recording device for up to three years uncovered AF in nearly 40 percent of patients. The authors of the multi-center study noted that improved stroke prevention measures require better strategies by health care professionals to identify and prophylactically treat AF patients at risk.
“The setting for proper screening will depend largely on the clinical scenario, but the results of these two reports clearly mandate that physicians have a high index of suspicion and that patients at risk be appropriately diagnosed and managed,” continued Dr. Kowey. “As health care professionals, we all must be able to recognize the signs of AF and, when diagnosed, to consider anticoagulation, which is the most effective way to help our patients reduce their risk for stroke.”