I get this newsletter, which is written by doctors for doctors. They had a lot to say about AFIB this week. Atrial Fibrillation: Guideline Update for Primary Care
AFIB NEWS FROM A MEDICAL NEWSLETTER - Atrial Fibrillati...
AFIB NEWS FROM A MEDICAL NEWSLETTER
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goldey
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"Heart Failure, Not Stroke, Most Common Complication of A-Fib"
People were scathing of the recent Daily Mail article but I don't think this article is any better.
It links a high rate of heart failures (HF) and strokes back to a previous diagnosis of AF, implying in the process that AF is the cause.
Yes, we know AF can be a cause for these but the co-morbidities often accompanying AF can also be the cause or a significant contributing factor. However, there doesn't appear to be any attempt to exclude the impact of co-morbidities in their results or even any acknowledgement in the report that AF is often accompanied by co-morbidities that contribute to the risk of HF and/or stroke i.e. AF is not the only cause and in some cases, could also be an "innocent bystander".
YMMV but I was underwhelmed by the report.
Quote from Dr Gupta of York Cardiology. "Its not the AF but the company it keeps".
BobD: Quote from Dr Gupta of York Cardiology. "Its not the AF but the company it keeps".
I believe Dr. Gupta was talking about blood thinners not heart failure. The point of these studies is that if afib is not appropriately treated it can lead the heart failure.
Does the phrase often used here "that any and all treatment for Afib is for quality of life" sound familiar to you? It's not only wrong, but can keep people from more agressively seeking proper treatment.
And while "afib won't kill you" -- another often used phrase here --may be literally correct, heart failure can kill you and improperly treated atrial fibrillation can lead to heart failure.
Jim
He was talking about stroke risk in as much as AF may be peripheral to all sorts of other morbidities. In other words maybe even a symptom rather than a cause.
As my post few minutes ago. My mum was totally let down. Now I understand about AF from my own diagnosis, I know just how much I could have fought.
You say that if it isn't treated appropriately that it can lead to heart failure so does that mean that for people who have had pace and ablate they are at greater risk of heart failure because it's still going on but it just isn't felt?
With pace and a ablate your heart rate is controlled. So where indicated, probably your best chance of reducing the risk of heart failure.
Jim
Hi Jim and Bob, my EP quoted the same, "Not the afib as life threatening but the company it keeps".
my EP quoted the same, "Not the afib as life threatening but the company it keeps".
Except it's not quite that simple. While the "company'" may certainly play a role in many cases, there's also emerging evidence that an increased afib burden by itself can increase the risk of heart failure as well as increased stroke risk.
So the problem with the statements like you quoted is not that they are necessarily incorrect, but without proper understanding can often result in complacency and bad treatment choices where a more aggressive treatment plan would serve them better.
Jim
Hi Jim, I think maybe just a statement made to bring home the risks. My EP is a top professor in the UK and works with scientists internationally. He does give good advice as he recommended ablation for me knowing that medication wasn't giving me quality of life with breakthrough episodes.
It links a high rate of heart failures (HF) and strokes back to a previous diagnosis of AF, implying in the process that AF is the cause.
I take the studies cited as a wake up call to doctors and patients alike that a fib has to be treated and monitored seriously -- or yes, heart failure can result.
Jim
Yes, that's the way I read it too.
I'm still of the view, like with the Daily Mail article, that bringing attention to AF is a good thing, even if it overstates it role. However, I feel for those of us with AF who get anxious when they hear about articles like this - especially one "by doctors, for doctors". Some will be thinking "I have a 40% chance of dying from heart failure" - even though others know that's not what they are saying.
Agree far too many read Dr. Google and associated articles.
We wouldn’t have too if our care was anything like acceptable. I am not even on a cardiologist’s books anymore. He signed me off as lockdowns ended. I’m not even monitored. All this guff about heart failure is really stressing me. I’m in permanent AF with a fast heart rate.
People should never be signed off from a cardiologist, once we have AF we always have AF and it can get worse with us all. If mine tried to sign me off, i would say to him,... am i cured then, .... and then tell him if he wont see me, to refer me to another one who will, I too get so annoyed with the NHS, I have just been on waiting list now for EKG as they seem to think i may have angina now, 8 Months in all on it, i emailed the hospital last week and i think it did some good because got appt. for next week. You know you can die waiting, and they are probably hoping most of us do to cut their lists, i am joking here, but it makes me feel like that. 8 MONTHS on list for initial appointment Re: possible Angina, just not good enough. NHS was good a few years ago, but abysmal now, the nurses and Drs. strike for more money, that is one service that has never been on strike before. Had my moan now.🖐️🖐️
I was discharged without even knowing it , until l tried to ringup the cardiac nurse. I was told l couldn't do that as l was off their list and to see my g.p.. Although my condition had worsened it took me a year to get a referral. The g.p. was very ignorant about a.f. and heart failure.
Is your GP monitoring your condition ? Best to have a semiannual or annual checkup.
No. No one is bothered about it. I will have to go and rattle some cages soon as I'm now getting swollen feet and ankles every night. Could be hormonal. But might be worse. Once I get my mum's house finally cleared and sold (nearly there) I will prioritise myself for a change.
Yes, how I wish they would, rather than almost trivialise it, as my GP did
Very interesting thank you, also the DOAC report as I have recently had my dose clinically reduced as per manufacturers guidelines on reaching 80, but this was at my initiative on reading the manufacturers guidelines
I have not read this article nor do i intend to, i have PAF take the thinners and Betablocker when i get an episode to bring h.rate back within around 3 hours. My cardio is not overly worried says as long as the thinners are taken.
My husband has COPD late stages which has led to h.failure as lungs affect the heart, but at no time has my own Cardio told me h.failure commonly follows AF.
Personally i think we all read far too much, should listen to our own Cardiologists and just LIVE, and not get carried away with the Maybe's.
We all will die one day of something its part of life. Just all with AF keep taking meds and if worried speak to your own Dr or Cardio. Less we use Dr Google the better.
The first sentence of your last paragraph is precisely how I feel. My mother had permanent AF for 30+ years, just on warfarin & occasionally beta blocker. Just got on with life. Never developed heart failure but did die of cancer at 80 (which it seems we all now have a 50% chance of being diagnosed with). We’re all going to die from something. Try to live well, eat well & get outside (if & when the weather finally improves!). Too much unnecessary stress in life already without constant health anxiety adding to it.
"Less we use Dr Google the better"
Isn't this forum effectively a part of Dr Google?
Not as far as i am concerned, the people commenting on here are usually AF sufferers, If one Googles AF, afraid it tells us all the worst scenario, and every case is different, only people to go to really are our Cardios. I used to be checking all sorts on Google, nearly had my funeral booked years ago as a result. Now what will be will be is my attitude.
My online research into afib and left atrial appendage occlusion has been invaluable to me (1) in having in-depth, knowledgeable conversations with my EP and cardiologist, (2) in understanding my role in improving my AF issues through lifestyle changes, (3) in deciding on the best course of treatment for me (I make my own health decisions, not the doctor), (4) in reducing my stress by having a wide range of relevant information, (5) in filling in the gaps in information not provided by busy professionals who may assume we know things we don’t or believe there are factors we don’t need to know about or are too dim to understand, (6) in being able to weigh the suitability and competence of professionals I consult, (7) in finding out information about the drugs I am prescribed so that I can weigh in intelligently and proactively on issues of dosage and duration especially when side effects are having a negative effect on my quality of life, (8) in giving me confidence that I can give my full trust to the providers I have chosen to treat me.
I should note that my research is limited to peer-reviewed studies on PubMed, Wiley, and other reputable sites. I pay no attention to blogs, even if by the apparently revered Dr. Gupta. I go straight to and only to actual research studies online. As for books, I found the John Day/Brunch book a good cheerleader at the beginning of my learning about afib, but short on being a solution to my particular afib journey. A few other books were helpful at the beginning (I read every book on Amazon the had Afib in the title), and some were outright quackery.
Dr. Google, just as any publication, is a valuable resource if judged perceptively, not used indiscriminately.
This is the world we live in now. I for one am grateful that I have so much information at hand so easily. In the old days (I’m 82), if I wanted to find independent information about a health issue, I had to go to the public library or the book section of a health food store, and even then the pickings were slim. The explosion of accessible information during my lifetime is mind-boggling And welcome
We need to employ critical thinking and be discriminating in anything we read or hear—anything…..including what doctors tell us. Not all doctors are the brightest bulbs, up to date, unbiased in their sometimes erroneous or debatable opinions. The more information I have, the better I am at being able to evaluate those with whom I need to trust my life.
So pleased for you that you have gotten so much out of publications, for myself, and respectfully to yourself, i only listen to my cardiologist, he is always available and answers my questions in laymens terms, i am not worried about my AF, although i see him every 6 months, he said to always ring him at the hospital and his Secretary will get him to either drop me a line on anything bothering me, or if i get changes in my condition.
Yes, afraid i am a Googler, much to my Husbands annoyance, he always tells me, to stop reading up on illnesses. Its true, last week i had a private appointment, as the wait on NHS would have been 22 weeks, because i was having gravelly voice and hoarseness for last 3 months and bit of pain beside windpipe, i convinced myself from what i read on Google that i should be booking the undertaker and that it just had to be Cancer. I saw the consultant 3 days ago, told him what i had read and he smiled and said dont read on line speak to professionals. I have bad Acid reflux and this has cause voice box to be inflamed and swillen, no cancers, i had worried myself sick with on line reading, wont be doing that again.
My understanding of "Dr Google" includes the practise of investigating your symptoms online with a view to self-diagnosing - either instead of or before seeking professional medical advice. Ditto for seeking treatment/remedy options.
Posts of that nature feature regularly on this forum.
My uncontrolled fast rate of a.f. caused me to go into heart failure. I would have a couple of days or a week or more of fast a.f. at 150 to 250 b.p.m. Nothing l did at home brought my heart rate down ,except for a couple of beats or more. It reverted when it wanted to. If l was taken into hospital l was only monitored and the nurses and doctor would rush to me and ask if was alright when my heart rate was particularly high. They just wanted to get an e.c.g. on paper for the consultant who wasnever there. They never tried to bring it down. So it was a waste of time going to hospital and l try to avoid it now.
Well i am gobsmacked really, as this is why people with AF get taken to hospital, i have gone in twice at the beginning and they kept me there after giving me 2 bisoprolol which began to bring the H.Rate down, but in all it always take mine 3 hours or so to go to normal, once it was back into the80's the hospital sent me home again. they dont do ECG initially. now i dont go to hospital, i just take 2 bisoprolol at home at it comes back down. luckily i ony have the PAF well for now anyway.
I have been admitted to hospital with afib after being sent to A&E but they just wait for it to revert to normal and then send me home, all the time monitoring me and sometimes doing tests. I know some hospitals try to bring the patients pulse down, but mine in Wales doesn't. The only time it was brought down was when l took my 300mg pip for the 1st time. I took my tablets with me a nd they connected me up to the monitors while l took them. They then left me and my partner by ourselves. I think the dose was too strong for me as it worked within half an hour and l flatlinedfor a few seconds. That is why you need to be in hospital for the 1st dose of a pip. Now l am in heart failure flecanide is not suitable for me. All the best to you.
300 mg of bisoprolol which i assume you have these beta blockers, is enough to kill a horse, my Cardio has me on (also the A & E when taken in there) 5 mg of bisoprolol and it still takes a good 3 - 4 hours to go to normal which for me is around 55 if i have an episode.
I question where you are actually going to be allowed to take 300 grms, who on earth ever told you to take this amount. Yes its true in hospital they just leave a person to see when the h.rate goes to accepted level then sent home. As i say you are lucky to still be be alive taking 300MG OF BETA BLOCKERS. i would strongly suggest you seek better advice, no one would ever take 300mg of a beta blocker.
Sorry , l didn't make it clear. The pip was 300mg of flecanide which is rhythm control drug , to get you back into n.s.r., which is normally given as a pip. Beta blockers like bisopropol just bring the rate down but you can still be in afib.
Sorry but with taking Bisoprolol or equivalent, taking this when an occurance of AF, brings rate down, thus, i am no longer in AF with normal heart rate. So not sure why you say this as my Cardio tells me, OK once back down, and A & E would not discharge people if as you say they can still be in AFib, after Rate gone back to normal.
They will discharge you because once the rate is down you are safe. Some people have a.f. without the rate of beats going up. Atrial fibrillation is an irregular heartbeat which you can have at many different rates.
Hi
Interesting.
My Embolic Stroke came out of the blue at 2am the day I mowed my small lawns. But I think that already had AF before the stroke diagnosis.
But 4 days later having a check on my Carotid arteries scan the scanner saw a shadow on my thyroid so later it was confirmed that I had papillary thyroid cancer.
Three diagnosis. STROKE Embolic, AF Rapid and Persistent and Thyroid Cancer.
Discharged on Metoprolol I struggled with a proven 186bpm Day H/Rate. Night avg is always 47bpm. I declined M.... but she ignored my voice. "It will make me breathless" and it did plus pauses at night.
No follow up after Stroke!
It was 2 years 3 months on Bisoprolol with 156bpm proven no pauses at night or breathless I was advised to see this private heart specialist.
Introduction CCB Diltiazem and some adjustment to both pulled me out of a miserable existence.
Been on this regime
Diltiazem 120mg AM for control of Day H/Rate. 60s now and 47avg Night.
Bisoprolol 2.5mg PM for control BP
Treating folks with stroke is so important. I was left which no doubt has cause damage to my heart. I have refused any direction from my Dr an Endocrinologist on stroke ward and the public heart specialist who left me such a high heart rate although she changed me off Met......
One thing which happened she used 24-hr heart monitor to start to see what Met.... was causing and rate, after starting Bisoprolol too and my private specialist directed her to do a 24-hr monitor to check Diltiazem. Success on it was appreciated.
So Stroke patients with AF need the correct med from the start.
Worryingly surgeons doing the various catheter ablations are being subjected to total high levels of radiation.
I didn't know catheter ablations involve radiation.
Anyone know that.
Luckily I am for 2 years 5 months controlled on heart rate and BP and I have been told no cardioversion, ablation or anti -arrhymnic meds.
Thanks again. Cheri JOY. 75 (NZ)
You mention in detail everything but the thyroid cancer, how did this turn out ?
Hi
With argument persuing with the Endocrinologist demanding that I wait 6 mths to have a thyroidectomy, the surgeon and anaesthetist argued as soon as possible.
Various tests biopsy, check on voice box I finally was seen to 4 mths lated very early February.
Full thyroidectory, 12 lymphs removed (2 affected) and partial dissection of lymph node central.
4th year - recalled after neck scan.
3 spots under suspicion. On Tuesday I undergo a PET/CT Scan which a solution radio active waves catches all movement in muscles, lymphs, veins, arteries and lights up any thyroid tissue which is cancerous.
3 spots are 6mm lymph, a 7mm lymph and a 19mm x 9mm ? behind. At the junction where carotid arteries, jugular veins and lymph nodes meet.
Fingers crossed. After having the infusion via intravenuous level, wait an hour or plus, into the 'barrel' and stay still 30mins.
I have refused sedative as I simply close my eyes for the duration.
Also wish to drive there and to the accommodation motel. I will be 5 hours R.A.
Anything RA I flee from but surgeon has changed me out of the RAI Scan which stopped my thyroxin - 3 days in which had a terrorifying effect coupled with a low iodine diet.
11 days later TSH was 5.8. Even after resuming.
Instead this works on sugar so not high activity 24 hours earlier, no carbs, no sugar basically.
The only PET SCAN in NZ.
With the King and Princess Katherine undergoing chemo/radiation it is terrible risk of leukaemia. That's why I would accept surgery 100%.
cheri JOY
Thanx for caring..
You really went through the wringer - suddenly having stroke, cancer and AFib to deal with. That must have been a dreadful time for you but thankfully a good outcome.
I didn't know catheter ablations involve radiation. Is it something you have read or were you told about it? I think it's an important point.
Hi
I enrolled with Radcliffe Research to receive live discussion in cardiac.
This was an interesting listen.
cheri JOY.
My guess and only my guess is that radio frequency (rf) is radioactive to some degree. At best it is the same EMF used by cell phones and towers which are detrimental to the overall Body frequencies. That can’t be good for doctors who work at close range with it on a regular basis .
Thanks for highlighting this, and it follows on from the Daily Mail article last week.
There is always such a fine line between fear and knowledge. Some feel reassured by knowing all they can and some find it too stressful.
I have read the study and I think the take away is that doctors need to be more conscious of the holistic health of the heart after an AF diagnosis, rather than simply sending people away with an anticoagulant in their pocket. The article is framed to educate doctors of the need to look at the wider implications of a diagnosis which have to date been largely ignored. I was particularly struck by the phrase “Think of atrial fibrillation as a barometer of underlying stress on the heart.”
If the risk of heart failure is twice that of stroke in patients with AF, then it is only right that awareness of this is raised with clinicians so that their medical focus and public communication strategies are adjusted accordingly. This will ensure we - both doctor and patient - are doing all that is possible to reduce this risk as early as possible through healthy eating, exercise, reducing stress, etc.
I totally agree we need to live for today and not get ourselves so bogged down in medicalised data it affects our ability to enjoy our lives today. We will all die of something: nobody is getting out of here alive! But I bear in mind this is a paper was written by doctors for doctors to inform best clinical practice going forward and I think its contents are positive step.
Hi
Yes, I agree but short cuts are taken or if your other diagnosis and age is against you it appears "one gets left".
Which is wrong. My Mum lived until 93 years and died of an undiagnosed urine infection which left her in bed at a upmarket retirement home.
Untrained carers could not spot the smell of her wrap around pad!
It was in a month I did not get down the 350kms to see her.
Anzac, Birthday and approaching mother's Day I was called in by the local hospital. Poor Mum. She was already semi-conscious.
Speaking to her Triage Team the following day I demanded she have more morphen. She died peacefully at 2am, I was with her.
cheri JOY. 75. (NZ)
The bit I found interesting was the comment by Dr Higgins, ‘Think of atrial fibrillation as a barometer of underlying stress on the heart.’ He advocates prevention of AF by attention to lifestyle and risk factors such a high BP, poor diet, lack of exercise etc from an early stage in the patient’s life. To me that is the most important conclusion in the article because basically the rest of it is showing that unhealthy people, some of whom already have heart failure, are likely to develop AF and suffer consequences from that as well.
Thanks for that. It’s not the best news but it’s very interesting.
I do wonder, though, whether AF itself isn’t also a “downstream risk” as the doctor puts it? If so, then to focus on it might be to take our eyes off the actual cause of heart failure, which might well not be AF - not least since so many people without AF also develop HF.
I have read also that the cause of HF is unknown, i.e. why some get it and some don’t (1 in 2, it seems). I should think genetics is at the heart of it.
AF might well be the first detectable sign many of us get of what are, in actuality, other much earlier but undetected cardiovascular changes. This means that any focus on AF prevention, needs a focus on improving cardiovascular health well before AF rears its head.
The earliest traces of cardiovascular distress that I’ve read of are found even in young people’s artery walls as a kind of early pre-atherosclerosis lesion.
It’s all very fascinating.
Thanks again for a most interesting article.
Steve
Thanks for passing on the medscape article. Information about afib online can be very helpful, but must be weighed, of course. I appreciated reading some of the comments in the article.
I’ve noted that others responding to you derogate looking online for afib information. Here is my response to that notion. I wanted to be sure you saw it and knew that many of us appreciated your sharing the link.
My earlier response:
“My online research into afib and left atrial appendage occlusion has been invaluable to me (1) in having in-depth, knowledgeable conversations with my EP and cardiologist, (2) in understanding my role in improving my AF issues through lifestyle changes, (3) in deciding on the best course of treatment for me (I make my own health decisions, not the doctor), (4) in reducing my stress by having a wide range of relevant information, (5) in filling in the gaps in information not provided by busy professionals who may assume we know things we don’t or believe there are factors we don’t need to know about or are too dim to understand, (6) in being able to weigh the suitability and competence of professionals I consult, (7) in finding out information about the drugs I am prescribed so that I can weigh in intelligently and proactively on issues of dosage and duration especially when side effects are having a negative effect on my quality of life, (8) in giving me confidence that I can give my full trust to the providers I have chosen to treat me.
I should note that my research is limited to peer-reviewed studies on PubMed, Wiley, and other reputable sites. I pay no attention to blogs, even if by the apparently revered Dr. Gupta. I go straight to and only to actual research studies online. As for books, I found the John Day/Brunch book a good cheerleader at the beginning of my learning about afib, but short on being a solution to my particular afib journey. A few other books were helpful at the beginning (I read every book on Amazon the had Afib in the title), and some were outright quackery.
Dr. Google, just as any publication, is a valuable resource if judged perceptively, not used indiscriminately.
This is the world we live in now. I for one am grateful that I have so much information at hand so easily. In the old days (I’m 82), if I wanted to find independent information about a health issue, I had to go to the public library or the book section of a health food store, and even then the pickings were slim. The explosion of accessible information during my lifetime is mind-boggling And welcome
We need to employ critical thinking and be discriminating in anything we read or hear—anything…..including what doctors tell us. Not all doctors are the brightest bulbs, up to date, unbiased in their sometimes erroneous or debatable opinions. The more information I have, the better I am at being able to evaluate those with whom I need to trust my life.”
Hi
Well, said.
Actually if you come across a Dr who has had AF - they are the best.
A Locum who appeared at my clinic had had AF. She was very knowledgeable and indeed she was interested in me.
Because even the Public Hospital Heart Specialist left me with rapid heart beat and BBs were working to control, this Locum asked me to go to a top private H/Sp who has become renown in Heart and med problems.
He introduced CCB Diltiazem and wow I never looked back.
CCB for heart rate control
BB for hypertension control.
cheri JOY. 75. (NZ)
I’ve often wondered if doctors would be so cavalier about “here, just take this drug for the rest of your life, bye now” if they themselves had ever taken that drug and experienced its effect on the quality of one’s everyday life—fatigue, brain fog, memory lapses, bleeds and bruises, etc.
That’s great that you found a doctor with AF! And one who got you into the right hands for meds.
interesting read . I wish they would have kept an eye on my husbands heart after his ablation . No blood thinners or regular checks given after . Hence stroke last July and heart failure .
But untreated, the company it keeps might come later as it progresses, that’s my interpretation and why, rightly or wrongly, I opted for an ablation sooner rather than later.
Best wishes
I don't think that AFib in itself will cause high blood pressure, overweight, clogging of the arteries etc. Many of those conditions come with age, and to some extent with a failure to take active steps to avoid them (not necessarily - I'm not intending to 'blame' the patient). It's more the other way around, ie many people who have hypertension, are overweight etc etc develop AFib.
I'm planning on going for a mini maze hopefully.
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