Webcast: Australian AF Guidelines

[Kaz747]

I listened to this webcast this morning whilst cooking up meals to freeze as I return to work next week.

This was recorded late last year after the release of the Australian AF guidelines. There probably isn’t anything new here for AF veterans but it could be of interest for newbies.

One point that was made was around alcohol. I’ve seen many posts here debating whether people could/should drink if it doesn’t seem to be a trigger for them. One doctor stated that “alcohol is a cardiac toxin” and the pharmacist reiterated that “alcohol is not favourable with anticoagulation”.

They also spoke about AF risks associated with obesity, sleep apnea, physical activity and pre-hypertension as well as the higher incidence of AF in people with depression. As we always advise, if needed, make the appropriate lifestyle changes.

heartfoundation.org.au/for-...

[BobD Volunteer]

And do remember that it was the LEGACY trials in Australia which showed the link with AF and obestity and how weight loss reduced AF burden. Thank you Kaz.

[Kaz747 in reply to BobD]

Towards the end of the webcast they discussed a case with a 67 yo women with a BMI of 33 and they said they would aim to get her BMI to 27.

[Hidden in reply to Kaz747]

My integrative doc says bmi of 27 for me is a good goal. Im 66 yr old, bmi was 34, now 31... slow crawl to 27 but Im having much less a fib so something is working for me. There is a school of thought that in the “ senior” population, a few extra pounds of wt can be a good thing if you become very ill. I guess you can afford to lose wt than someone who is very thin.

[Kaz747 in reply to Hidden]

Yes I’ve heard that before. One cardiologist who is often on the radio calls it “the weight paradox”. He explains it here:

m.switzer.com.au/the-expert...

[Hidden in reply to Kaz747]

Interesting! Thanks. I know I still need to drop another 30-40 lb, but my arthritic knee is more my motivation as they say losing one lb is equivalent to losing 4 lb on the knee.

[Auriculaire in reply to Hidden]

My BMI is around 31/32 but all the time I was dancing it hovered around 30. I am short but when I was dancing my legs and bottom were solid muscle . I never had any problems with fitness. Now I have lost a cm in height , my leg muscle has largely gone to fat but due to tendon problems exercise is very difficult. If I walk more than 10/15 mins I get pain in my Achilles tendons and I am terrified of rupturing them. Using my exercise bike makes the tendonitis in my hips worse. I can manage to work 2/3 hours in the garden days without rain but at the cost of some aches . My doctor says this amount of activity is enough at my age (67) and has never suggested I lose weight. I don't know really if I could apart from by starving myself. My appetite is much less than it used to be and I eat a lot less. I do not eat processed or sugary food ( apart from occasional desserts and two squares of dark chocolate a day). But I am less active. I don't think a reduction in my thyroxine and being on a beta blocker help in the weight department either!

[Kaz747 in reply to Auriculaire]

Drugs certainly don’t help. I used to be a dancer too. I had great legs in those days. And I’m with you - just had my 2 squares of dark chocolate with a cup of peppermint tea.

[Hilly22]

Thanks for posting this Kaz. Interesting point from the pharmacist. When I started on Apixaban I learned that alcohol increases the HASBLED score, which would be why the dispensing pharmacist warned me not to have more than one or two units a day ...

[Kaz747 in reply to Hilly22]

That’s what a lot of my research showed too - bleeding risk plus extra pressure on the liver which can affect the processing of medication. Not to mention the risk of doing something stupid from too much alcohol which I guess increases bleeding risk, eg falling.

[BobD Volunteer in reply to Kaz747]

I remember years ago a doctor at HRC discusssing when to anticoagulate saying he would never consider it with an alcoholic!

HASBLED by the way was explained to me as an aide memoir of things to address before anticoagulation NOT a contra score to CHADS2VASC. In other words you don't take one from t'other and Chads2vasc should prevail.

[Hilly22 in reply to Kaz747]

Absolutely agree Kaz. There's been a lot of discussion on here about alcohol being avoided due to its being a trigger for AF, but little mention of the fact that if taken in quantity (more than 2 units) it can increase the anticoagulant effect, and therefore increase the risk of bleeding. And like you said, add on the increased risk of an accident such as a fall and you have a recipe for disaster.