does af shorten life?

[maddogbabe99]

does af shorten life?

[BobD Volunteer]

There is no evidence to suggest that AF alone with no other co morbidities has any affect on life expectancy provided that all the risks are calculated and taken account of. By that I mean stroke risk should be assessed by CHASD2VASC2 and if appropriate adequate anticoagulation prescribed AND TAKEN. AF increases stroke risk by 500% you see. Look up CHADS2VASC2 on the main AFA website and there is a calculator there you can use to check your own risk status.

Bob

[CDreamer]

Hi again maddogbabe can you please tell us a little about yourself? Have you had a diagnosis of AF? If so when?

What are your concerns? People here are very happy to share their experiences from which you can learn but it is very helpful to have a little background on posters such as age, where in the world they live, when was your first episode, are you being treated for AF, are you taking anti-coagulants, that sort of thing.

You can post that background stuff on your profile so people can check back before they answer you so you don't have to repeat all the time.

[CDreamer]

Thanks for the link Ectopic, very interesting for those who like the facts and I would say this is a newbie who may want a bit of reassurance?

I am struggling to understand what this study really means for me personally and it sounds quite scary and very abstract.

"most studies have found that AF conferred excess risk of death, with a risk of all-cause mortality ranging from an adjusted relative risk of 1.3 to an unadjusted relative risk of 2.6"

Does this mean I am 3x more likely to have an excess risk of death because I have AF? Well I would say I have a 100% risk of death because I am mortal, whether or not I have AF. I am assuming that 'all-cause mortality' would include AF induced stroke? I haven't time right now to read the full thing, but will later.

I find pure statistics very hard to understand whereas maybe you find them helpful. Having talked to several statisticians I also know that the way the study is conducted drastically influences the findings, depending on "what syll - able you put your emphasis"

very best wishes

[CDreamer]

Thanks Ectopic still not crystal but much less foggy!

[AnticoagulateNow]

I would imagine the greatest risk of death associated with AF would be through stroke. If this is true, then the effective use of proper anti-coagulation must have a huge affect on the figures. Is everyone in the sampled AF group properly anti-coagulated? If not, or it's not known, then it's fairly obvious that this cohort is at greater risk of premature death. The only surprise is that the figure of 1.5x seems very optimistic alongside all other stats previously available.

I haven't read the Framlingham Study in full but hopefully it puts anti-coagulation into context when describing statistical risk. Otherwise it's summary, highlighted by ectopic 1 is entirely meaningless......

[Jason1971 in reply to AnticoagulateNow]

I think there are lots of ifs and buts in this article and the extract below would lead me to believe anti coagulation is not taken into account. At the AF Patients day I was told anti-coagulation can cut the risk of stroke by two thirds, assuming you are in the right range, but two thirds is better than nothing.

Most of the follow-up occurred before the availability of echocardiography and the widespread use of anticoagulants and antiarrhythmics for AF. The lack of routine echocardiography undoubtedly contributed to some misclassification of valvular heart disease. Moreover, we have insufficient data to comment on whether the mortality of AF is altered by anticoagulants or antiarrhythmics, as suggested by others. However, studies suggest that only about one third of eligible AF patients in the United States receive warfarin. Therefore, we believe that our mortality data may have relevance to most subjects with AF, given current treatment practices.

[Hidden]

The figures don't mention whether the people in the group were being treated for AF. If the group included people who were NOT being treated (maybe most were not treated?) they are bound to be a lot higher than if they were being treated.

As I've said before, a lot of stats are produced that say people with AF are at risk of whatever, but I wonder whether the stats should actually say "people with untreated AF" are at risk ???

K

[gerryatriq in reply to Hidden]

by not being treated you presumably mean not anticoagulated. that would hopefully mean, not diagnosed in the first place, which I would have thought was a very low figure. (well it should be if GPs are doing their jobs correctly).

Given that, how would they know if someone had AF after death?

So I would assume that figures are for those diagnosed with AF..whilst alive?

[Hidden in reply to gerryatriq]

I just mean untreated in whatever way but, yes, anti-coags possibly being the most important. So if someone had AF that was caught early on, and it was controlled by drugs, a successful ablation, or a bit of both,then I'm guessing that their outlook (hopefully!) wouldn't be much different to a "normal" person ???

If the stats were produced just for people being treated, or not being treated, I'd have thought they would have said so. But as nothing has been said, that I've seen anyhow, then I suppose the group is a mixture of people with and without treatment, and no doubt a lot that are treated but who's condition was caught late.

I'm just guessing but seems to make sense to me.

Koll

[Hidden in reply to gerryatriq]

PS. Forgot to say that I probably had AF for 10 years prior to diagnosis and I think that may apply to quite a few people, though maybe not so long? That is aggravated by GP's not understanding symptoms and sending patients away until the situation develops. Certainly my GP's, a number of them, never picked it up till it was really bad.

But as I think you're saying, if they hadn't been diagnosed they wouldn't be in the figures.

[gerryatriq in reply to Hidden]

I was in the same boat as you, years ago. (now 15 years ago)

Visit after visit to GP complaining of tiredness and lethargy, went on for good couple of years. GP only ever took my BP, which was fine. I gave up in the end thinking it was just symptoms of getting older. The AF was discovered totally by accident after I received an electric shock and was advised to go to a GP while I was on holiday. they were more surprised than I was that I was not being medicated for it, and was put on warfarin immediately.

It really should be as normal as saying hello, that all GPs should check everyones pulse as a matter of course. That would at least be a simple cheap screening for all that visit a surgery each year.

[BobD Volunteer]

I agree Koll which is why I said that provided you were being treated and your stroke risk assessed and treated etc. That study is also quite old from memory. People have been quoting it for as long as I can remember and we have come a long way since then. My personal view is that as CDreamer stated we will all die sometime so by taking all precautions all we do is delay the process and by worrying we may well speed it. I had AF and my life expectancy is slightly reduced but not by the AF but a second problem I developed later and unrelated so why worry about something that may never happen. There is lots of space debris up there which could fall on us! LOL

Bob

[Offcut]

Over worrying could shorten your life more. Take the treatment and it will control the AF. Control it do not let it control you!

Be Well

[excalibur]

As a gut reaction to the study above (which I haven't read) I would feel that if you have ever been diagnosed with AF, it's possible that you may have a slightly worse life expectancy than someone who has never had AF and had a "better" cardiac function

But the issue for me (I am in permanent AF) was should I try to get back in NSR through a series of ablations even though the chance of success was less than 50% in my case.

I asked my cardiologist in if my life expectancy be higher if I was in NSR as a result of successful ablations than if I elected to stay in AF. He (and more than one other EP or cardiologist since then) said that there was no evidence that getting me into NSR would improve my life expectancy, given that my AF was being managed effectively (warfarin, blood pressure drugs, statins & a good heart function report from my echocardiogram)

Or should I revisit the options. Maybe it would be helpful for the AF Association to "interpret" this study to try and see what it really shows

Hope to see some of you tomorrow in Taunton

Lance

[Steve112]

Stats are all very confusing and probably can be used to suit any argument or slant you wish to promote...I would never had known I have Paf if not having a minor op on my knee and thanks to that it seems I am now on warfarin for life despite no symptoms whatsoever and being told by two specialist that having a anesthtic cause can an episode of AF something that may never ever happen again buts it's best to stay on warfarin just in case..people say read as much as you can on AF but I'm not sure that helps as there is so much contradictory opinion at present I am at the centre of four so called experts in their field all with differing opinions of what I should be doing with regards warfarin...

[AnticoagulateNow]

Sorry ectopic, are you the author of the Framlingham Study? Perhaps that is why you defend it with such passion. But try not to let that passion overflow with rudeness, there's a dear. I'm not certain whether 'tis I or Jason (or both of us) who is the target of your unwarranted outburst but neither of us deserve it.

[Jason1971]

Wow, I didn't mean to offend. I did read the article, but don't proclaim to have understood it all. I thought the extract above was relevant to the line of discussion about anti-coagulation. I wasn't challenging the validity of the article, just trying to help with the line of inquiry. I believe this forum is here to help and I have certainly benefited from it. I only try to do the same.