Burden of AF
Atrial Fibrillation is a chronic and typically progressive disease, which burdens patients with frequent and repeated episodes over their lifetime.19
AF increases a patient’s risk of life-threatening complications, such as stroke, heart attack, and heart failure. Patients with AF have a 46% higher risk of mortality than individuals without AF.5,6
Up to 47% of patients with AF report a reduced quality of life, 25% report a disruption to daily activities and 19% impaired functional status.4,7,8 Caring for patients with AF can be burdensome, as caregivers experience considerable disruptions to their daily lives, such as disrupted schedules and a financial burden.11,12
Public health challenge
Atrial Fibrillation (AF or AFib) is the most common form of cardiac arrhythmia, and is becoming an increasingly prevalent and significant public health challenge.1 In Europe, AF affects 11 million people, with 886,000 new people being diagnosed each year.2
AF has a significant impact on the quality of life of patients, with similar reductions in quality of life seen in people with coronary artery disease, congestive heart failure and history of heart attack.3,4 Patients with AF have a 46% higher risk of mortality than individuals without AF.5,6
Up to 47% of patients with AF report a reduced quality of life, 25% report a disruption to daily activities and 19% impaired functional status.4,7,8 In patients with AF, there are several factors that pose a burden on patients. Have a look at the image to understand each of these factors.
With disease progression, patients are more likely to experience severe mobility problems, issues with self-care, increased pain and discomfort as well as anxiety and depression.9 Psychological distress which may include anxiety and/ or depression has the potential to increase both mortality and morbidity in patients with AF.10
How does AF impact family members?
Caring for family members with AF can be burdensome.11,12 Some form of caregiver assistance is required for 63% of elderly patients and 80% of patients recovering from stroke,11,12 which can take the form of monitoring signs of bleeding, opening medication packaging, among many other forms.13
Caregivers of patients with AF experience considerable changes to their daily lives, including disrupted schedules, financial burden, lack of family support, and health problems. Caregivers experience considerable disruption to their schedules and are at a high risk of burnout when:11,14
The burden to caregivers may lead to less adequate patient support, physical and emotional stress, caregiver burnout, and suboptimal patient outcomes.13 Over 40% of stroke patients receiving care need another caregiver by the third month of recovery.11
How does stroke impact quality of life?
Stroke, one of the most serious potential consequences of AF, can cause a significant impairment in physical, psychological and social function.15 Key limitations after a stroke include paralysis, depression, personality changes, problems with communication, anxiety, memory loss, and cognitive impairment.15
30% of patients who experience a stroke will suffer from a second stroke, with the risk of a second stroke nearly 9x higher than the risk of stroke in the general population.16 Stroke is typically more severe and devastating among patients with AF than individuals who do not have the condition.17,18
How does AF treatment affect quality of life?
Antiarrhythmic drugs for managing AF can cause significant side effects, including drug-drug interactions and irregular heartbeats that cannot be distinguished from AF itself.19,20 Concerns over side effects may contribute to patient anxiety which impacts on quality of life.21,22,23,24
Regarding treatment for stroke, while oral anticoagulation (OAC) therapy does reduce the risk of stroke and prolongs life, it increases the risk of bleeding in patients with AF.25,26,27,28 OAC therapy can also be burdensome to patients, as it requires frequent and regular visits to the hospital to monitor and optimise dosage,29,30,31 and can disrupt daily activities.30,31
The new millennium epidemic
AF is the new millennium epidemic that affects millions of lives, mostly affecting the middle-aged and elderly. Watch this video to understand the full scope of the burden of the disease.
A new report released during AF Association Global AF Aware Week highlights AF as one of the world’s most significant health issues. You can download the full report ‘The Burden of Atrial Fibrillation: Understanding the Impact of the New Millennium Epidemic Across Europe’ here!
1. Lip GYH, et al. (2016) Atrial Fibrillation. Nature Reviews, Disease Primers. Vol. 2. doi:10.1038/nrdp.2016.16 . Published online 31 March 2016. 2. Global Burden of Disease Collaborative Network (2016) Global Burden of Disease Study 2016 (GBD 2016) Results. Seattle, United States: Institute for Health Metrics and Evaluation (IHME), 2017. Accessed 2018-04-20. Available from http://ghdx.healthdata.org/gbd-results-tool. 3. Thrall G, Lane D, Carroll D, Lip GY (2006) Quality of life in patients with atrial fibrillation: a systematic review. Am J Med 119 (5): 448.e441-419. 4. Dorian P, Jung W, Newman D, Paquette M, Wood K et al. (2000) The impairment of health-related quality of life in patients with intermittent atrial fibrillation: implications for the assessment of investigational therapy. J Am Coll Cardiol 36 (4): 1303-1309. 5. Odutayo A, Wong CX, Hsiao AJ, Hopewell S, Altman DG et al. (2016) Atrial fibrillation and risks of cardiovascular disease, renal disease, and death: systematic review and meta-analysis. Bmj 354 i4482. 6. Boriani G, Proietti M (2017) Atrial fibrillation prevention: an appraisal of current evidence. Heart (0):1–6. 7. van den Berg MP, Hassink RJ, Tuinenburg AE, van Sonderen EF, Lefrandt JD et al. (2001) Quality of life in patients with paroxysmal atrial fibrillation and its predictors: importance of the autonomic nervous system. Eur Heart J 22 (3): 247-253. 8. Roalfe AK, Bryant TL, Davies MH, Hackett TG, Saba S et al. (2012) A cross-sectional study of quality of life in an elderly population (75 years and over) with atrial fibrillation: secondary analysis of data from the Birmingham Atrial Fibrillation Treatment of the Aged study. Europace 14 (10): 1420-1427. 9. Dudink E, Erkuner O, Berg J, Nieuwlaat R, de Vos CB et al. (2017) The influence of progression of atrial fibrillation on quality of life: a report from the Euro Heart Survey. Europace. 10. Aliot E, Botto GL, Crijns HJ, Kirchhof P (2014) Quality of life in patients with atrial fibrillation: how to assess it and how to improve it. Europace 16 (6): 787- 796. 11. Oliva-Moreno J, Pena-Longobardo LM, Mar J, Masjuan J, Soulard S et al. (2018) Determinants of Informal Care, Burden, and Risk of Burnout in Caregivers of Stroke Survivors: The CONOCES Study. Stroke 49 (1): 140-146. 12. Chen SY, Vanderpoel J, Mody S, Nelson WW, Schein J et al. (2012) Caregiver assistance among Medicare beneficiaries with atrial fibrillation and factors associated with anticoagulant treatment. Am J Geriatr Pharmacother 10 (5): 273-283. 13. Ferguson C, Inglis SC, Newton PJ, Middleton S, Macdonald PS et al. (2015) The caregiver role in thromboprophylaxis management in atrial fibrillation: a literature review. Eur J Cardiovasc Nurs 14 (2): 98-107. 14. Coleman CI, Coleman SM, Vanderpoel J, Nelson W, Colby JA et al. (2012) Factors associated with ‘caregiver burden’ for atrial fibrillation patients. Int J Clin Pract 66 (10): 984-990. 15. Lo Buono V, Corallo F, Bramanti P, Marino S (2017) Coping strategies and health-related quality of life after stroke. J Health Psychol 22 (1): 16-28. 16. Burn J, Dennis M, Bamford J, Sandercock P, Wade D et al. (1994) Long-term risk of recurrent stroke after a first-ever stroke. The Oxfordshire Community Stroke Project. Stroke 25 (2): 333-337. 17. Hannon N, Sheehan O, Kelly L, Marnane M, Merwick A et al. (2010) Stroke associated with atrial fibrillation--incidence and early outcomes in the north Dublin population stroke study. Cerebrovasc Dis 29 (1): 43-49. 18. Andrew NE, Thrift AG, Cadilhac DA (2013) The prevalence, impact and economic implications of atrial fibrillation in stroke: what progress has been made? Neuroepidemiology 40 (4): 227-239. 19. Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D et al. (2016) 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J 37 (38): 2893-2962. 20. Dan GA, Martinez-Rubio A, Agewall S, Boriani G, Borggrefe M et al. (2018) Antiarrhythmic drugs-clinical use and clinical decision making: a consensus document from the European Heart Rhythm Association (EHRA) and European Society of Cardiology (ESC) Working Group on Cardiovascular Pharmacology, endorsed by the Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS) and International Society of Cardiovascular Pharmacotherapy (ISCP). Europace. 21. Nazli C, Kahya Eren N, Yakar Tuluce S, Kocagra Yagiz IG, Kilicaslan B et al. (2016) Impaired quality of life in patients with intermittent atrial fibrillation. Anatol J Cardiol 16 (4): 250-255. 22. Aliot E, Botto GL, Crijns HJ, Kirchhof P (2014) Quality of life in patients with atrial fibrillation: how to assess it and how to improve it. Europace 16 (6): 787- 796. 23. Serpytis R, Navickaite A, Serpytiene E, Barysiene J, Marinskis G et al. (2018) Impact of Atrial Fibrillation on Cognitive Function, Psychological Distress, Quality of Life, and Impulsiveness. Am J Med. 24. Wang Y, Kong MC, Lee LH, Ng HJ, Ko Y (2014) Knowledge, satisfaction, and concerns regarding warfarin therapy and their association with warfarin adherence and anticoagulation control. Thromb Res 133 (4): 550-554. 25. Connolly SJ, Ezekowitz MD, Yusuf S, Eikelboom J, Oldgren J et al. (2009) Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 361 (12): 1139-1151. 26. Rocket AF Study Investigators (2010) Rivaroxaban-once daily, oral, direct factor Xa inhibition compared with vitamin K antagonism for prevention of stroke and Embolism Trial in Atrial Fibrillation: rationale and design of the ROCKET AF study. Am Heart J 159 (3): 340-347 e341. 27. Giugliano RP, Ruff CT, Braunwald E, Murphy SA, Wiviott SD et al. (2013) Edoxaban versus warfarin in patients with atrial fibrillation. N Engl J Med 369 (22): 2093-2104. 28. Granger CB, Alexander JH, McMurray JJ, Lopes RD, Hylek EM et al. (2011) Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med 365 (11): 981-992. 29. Lane DA, Aguinaga L, Blomstrom-Lundqvist C, Boriani G, Dan GA et al. (2015) Cardiac tachyarrhythmias and patient values and preferences for their management: the European Heart Rhythm Association (EHRA) consensus document endorsed by the Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLEACE). Europace 17 (12): 1747-1769. 30. Suarez Fernandez C, Castilla-Guerra L, Cantero Hinojosa J, Surinach JM, Acosta de Bilbao F et al. (2018) Satisfaction with oral anticoagulants in patients with atrial fibrillation. Patient Prefer Adherence 12 267-274. 31. Ynsaurriaga FA, Peinado RP, Ormaetxe Merodio JM (2014) Atrial fibrillation and quality of life related to disease and treatment: focus on anticoagulation. Future Cardiol 10 (3): 381-393.
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