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Undiagnosed atrial fibrillation may be common, according to a new study co-authored by Lankenau Heart Institute cardiologist

Lankenau Medical Center September 25, 2017 Research News

The incidence of undiagnosed atrial fibrillation (AFib or AF), a type of irregular heartbeat, may be greater than most physicians realize, according to a new study co-authored by Peter R. Kowey, MD, a world-renowned cardiologist at Lankenau Heart Institute in Lankenau Medical Center, and the William Wikoff Smith Chair in Cardiovascular Research at Lankenau Institute for Medical Research, both part of Main Line Health.

In a three-year, multi-center clinical study, Dr. Kowey and his colleagues showed that continuous monitoring of a previously undiagnosed at-risk population uncovered AFib in nearly 40 percent of patients. The results are significant because, in many patients, the symptoms of AFib are silent or minor.

“I’m beginning to think of atrial fibrillation as an epidemic,” said Dr. Kowey. “Our population is aging and has many of the risk factors for the disease. We may be seeing the early signs of a perfect storm.”

In the study, 385 undiagnosed at-risk patients were fitted with miniature implantable recording devices. The detection rate for AFib rose through the study’s length. At 18 months, almost 30 percent of study participants were found to have AFib. After two years of wearing the device, 33 percent of participants were found to have AFib.

“We know that AFib is a progressive disease,” said Dr. Kowey. “As such, it seems appropriate to suggest that aggressive monitoring of at-risk populations by clinicians is warranted, because we now know that a significant percentage of them will have AFib.”

AFib markedly increases a patient’s risk of having a 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). Risk factors for AFib include age, high blood pressure, diabetes, obesity, kidney disease, sleep apnea and chronic obstructive pulmonary disease.

Patients’ symptoms can be well managed with anti-coagulant medications, said Dr. Kowey. “We can treat AFib, which reduces the patient’s risk of a stroke,” he said. “In fact, this is one area where the medical community can have a major impact on the health of a large number of people: diagnosing atrial fibrillation and treating it to reduce the incidence of catastrophic stroke.”

He advises that patients with risk factors for AFib and those who are experiencing heart palpations consult their doctors about being tested.

“The setting for proper screening will depend largely on the clinical scenario, but the results of this report clearly mandate that physicians have a high index of suspicion, and that patients at risk be appropriately diagnosed and managed,” he said.

The results of the study, “Incidence of previously undiagnosed atrial fibrillation using insertable cardiac monitors in a high-risk population: The REVEAL AF study,” were published in a recent issue of the biomedical journal JAMA Cardiology and presented at an international medical conference in Barcelona, Spain, in August.

About Main Line Health

Founded in 1985, Main Line Health is a not-for-profit health system serving Philadelphia and its western suburbs. Main Line Health's commitment—to deliver advanced medicine for treating and curing disease, playing an important role in prevention and disease management as well as training physicians and other health care providers—reflects our intent to be the region's premier choice for clinical care, research, and education. A team of more than 10,000 employees, 3,000 nurses and 2,000 physicians care for patients throughout the Main Line Health System.

At Main Line Health's core are four of the region's most respected acute care hospitals—Lankenau Medical Center, Bryn Mawr Hospital, Paoli Hospital and Riddle Hospital—as well as one of the nation's premier facilities for rehabilitative medicine, Bryn Mawr Rehabilitation Hospital.

Main Line Health also includes Mirmont Treatment Center for drug and alcohol recovery; Main Line Health HomeCare & Hospice, which includes skilled home health care, hospice and home infusion services; Main Line Health Centers, primary and specialty care, lab and radiology, and other outpatient services located in Broomall, Collegeville, Concordville, Exton, King of Prussia and Newtown Square; Lankenau Institute for Medical Research, a biomedical research organization; and Main Line HealthCare, one of the region's largest multispecialty physician networks.

Main Line Health is the recipient of numerous awards for quality care, and service, including U.S. News & World Report's Best Hospitals, System Magnet® designation; the nation's highest distinction for nursing excellence and the Mid-Atlantic Alliance for Performance Excellence (MAAPE) Excellence Award. Main Line Health is committed to creating an environment of diversity, respect, equity, and inclusion, has proudly received awards in this area and has embraced the American Hospital Association's #123forEquity Pledge to Act to eliminate disparities in care. We are dedicated to advancing patient-centered care, education, and research to help patients stay healthy and live their best lives.

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About Lankenau Heart Institute

The Lankenau Heart Institute is Main Line Health’s premier, comprehensive cardiovascular medicine and surgery program. The Lankenau Heart Institute brings together the clinical expertise of all four Main Line Health acute care hospitals and community cardiology practices to ensure that patients receive a level of quality, service, and experience that is unprecedented in the region. Through the system-wide coordination of services, the Lankenau Heart Institute delivers preventive, diagnostic, therapeutic, and rehabilitative cardiovascular services at each of our locations including Lankenau Medical Center, Bryn Mawr Hospital, Paoli Hospital and Riddle Hospital.

Lankenau Heart Institute continues to be a pioneer in the use of beating-heart techniques and robotic-assisted procedures for coronary artery revascularization, minimally invasive and transcatheter approaches for valve repair and replacement, and complex aortic surgeries. With our growing experience and focus on minimally invasive techniques, Lankenau Heart Institute has expanded participation in clinical trials year over year. Our physicians are frequently invited to participate in clinical/medical device trials, many of these designed to facilitate minimally invasive procedures/approaches.

With a collaborative team of expert consultative cardiologists, interventional cardiologists, electrophysiologists, cardiovascular surgeons and specially trained nurses and technologists, the Lankenau Heart Institute is dedicated to managing and treating patients with heart failure, aortic disease, coronary and peripheral vascular disease, heart rhythm disorders and valve disease. Our team of cardiologists and cardiac specialists provide patients and their families with expert cardiac care, close to home.

About Lankenau Institute for Medical Research

Lankenau Institute for Medical Research (LIMR) is a nonprofit biomedical research institute located on the campus of Lankenau Medical Center and is part of Main Line Health. Founded in 1927, LIMR’s mission is to improve human health and well-being. Faculty and staff are devoted to advancing innovative new approaches to formidable medical challenges, including cancer, cardiovascular disease, gastrointestinal disorders and autoimmune diseases, such as diabetes and arthritis. LIMR’s principal investigators conduct basic, preclinical and translational research, using their findings to explore ways to improve disease detection, diagnosis, treatment and prevention. They are committed to extending the boundaries of human health through technology transfer and training of the next generation of scientists and physicians.