I have just been diagnosed with AF which I think was triggered by a recent bout of covid. I've been told I'll be starting beta blockers - was going to be Sotalol but they changed their minds and it'll be Bisoprolol. Initially I was pleased when the arrhythmia nurse said I wouldn't need anticoagulants as my Chads Vasc score is low, however I've just read a post from the AFA site that 1 in 3 people will experience a stroke without medication. Ive also read that covid is a further clot risk. Not sure what to do now or who to speak to about this. They haven't mentioned me seeing anyone again, just picking up the Bisoprolol from my GP. Is anyone else on beta blockers but not anticoagulants?
Should I be worried?: I have just been... - Atrial Fibrillati...
Should I be worried?
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Dwts20
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I have taken beta blockers in the past for thyroid disease so no anticoagulant needed but then I was on them again for Afib, I only started anticoagulants when I was diagnosed with heart block and had a pacemaker fitted so now take both.
Maybe speak to your arrhythmia nurse about your concerns.
BobDVolunteer
The need or not for anticoagulation is defined by your Chads2Vasc2 score. This uses co morbidities such as high blood pressure, presence of diabetes, prior stroke, age and gender to give a score and on the score of 1 to 5 depends on your need. You can google Chads2Vasc2 and do the score yourself but be aware that a score can not be undone, For example if you take blood pressure meds but have normal BP you still score. Generally speaking a person under 65 with no other health issues is more at risk taking anticoagulants than not but it is a fluid situation and we are all different.
Thanks for your reply, Bob. I have a Chads Vasc score of 1, so I assume that makes me a lower risk. I'm not sure what you mean by this, though? -"Generally speaking a person under 65 with no other health issues is more at risk taking anticoagulants than not but it is a fluid situation and we are all different."
Do you mean risk from the anticoagulants themselves?
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A score of 0ne means anticoagulants are optional. Two means advised. Three and + defintely.
Regarding risk, nothing is without risk so if you give anticoagulants to 1000 people, one may suffer a life threatening bleed. (especially if they already have a latent problem such as a stomach ulcer or bowel polyps , serious head injury etc. ) Strangely I have known of people for who this has been life saving as anticoagulation has enabled a latent bleed to be seen allowing the discovery of a previously unknown cancer so its not all bad.
I have a chads score of 4 -1 for over 65 1 for being female - 1 for afib -1 for heart failure so am on anticoagulants but I can't get my head around how this works it says 4 % and then 40% over 10 years does anyone know what it actually means?
The % is per year so yes after ten years 4%x10=40% Your score is actually 3 since none is actually given for AF. It is AF which calls for the score system.
On gp notes it says 4 but I don't have any other health conditions I will have to ask next time thanks for replying I am 71 so another point will be added at 75 I suppose
You no longer get a score for being female, as this was changed and removed from the scoring system about two months ago. Essex cardiothoracic Unit confirmed this to me. You do still get scored for being 65 and above. Your score at the moment is actually 2 currently and then 3 when you are 75.
The change hadn’t filtered through to my GP and I don’t think it’s filtered through to many areas at all. They changed my score when I informed them and they saw the letter from cardiology mentioning it.
Thanks for that how interesting, as I mentioned I have a score of 4 so was wondering where the extra points came from anyway unless I have something I don't know about! If this score is documented I presume it should be accurate for any future treatments or medications or is it just to justify being on anticoagulants.
As Bob said, you don’t and shouldn’t get a point for having AF, most definitely. That doesn’t exist. Next time you’re at an appointment ( probably best Cardiology) might be worth asking them what your risk score is and why. They should be up to date with the female score being removed too by that time.
Here is a link to the Anticoagulation and AF info sheet api.heartrhythmalliance.org...
Further reading available here heartrhythmalliance.org/afa...
I came off both bisoprolol and anticoagulant (Apixaban) following an ablation because I don’t meet the chads vasc score.
Best wishes
I take bisoprolol and no anticoagulant, these people know what they are doing, if you are in sinus then all is fine, if you go in to afib for more than a day the anticoagulant is a must. You seem to be taking this all quite well. Good luck on your journey.
"if you go in to afib for more than a day the (sic) anticoagulant is a must"
Is that just your opinion or is it backed up by documented medical advice? My CHA₂DS₂-VASc Score is currently 0 and I have not been advised to start AC if I have an episode lasting more than 24 hours.
Similarly, my understanding of the CHA₂DS₂-VASc Scoring system is that it does not take the duration (or frequency) of AF episodes into consideration i.e. whether to take AC or not is not determined by any time threshold for an episode.
As I have posted here before, the EP I saw told me that I was not at risk of stroke unless I experienced a lengthy episode of AF with a high heart rate (irregular, of course!). He prescribed Flecainide for me to take as a PiP and that ended episodes in a few hours. Now I take it regularly and it has virtually put an end to episides I am not “at risk of stroke” and am still here at 80, despite no longer taking anticoagulants with their nasty side effects.
What's his definition of "lengthy"?
I think it was 10, 12 hours or more.
Hi Vonnegut, did you yourself experience bad side effects and from which anti/coag, what effects did you experience.
Dreadful soft stuff from the Rivaroxyban and the opposite from the Epixoban and others but the Flecainide has similar side effects though not as bad!
It’s what my ep and cardiologists at my visits to A&E have told me, if I ever go in to fast afib I go to hospital, mind you I have hit 300bpm before, not nice.
I’d suggest you need coagulating if in afib for anything longer than 24hrs, from what I’ve learnt over the years.
I don't think there is a great deal of certainty on how long you need to be in AF before starting to take AC. Certainly the risk appears to increase as minutes turn to hours and possibly as hours turn to days but let's not forget that we're all different as well.
The REACT-AF trial currently underway (PIP AC in response to AF episodes) requires participants to start taking AC for 30 days after only 1 hour of AF. However, that appears to be conservative as it needs to allow for participants only being required to wear their monitoring device (Apple Watch (modified version?)) for a minimum of 14 hours a day. That means as a worst case scenario an event starts just after they take their watch off and is not recorded until they put it back on 10 hours later i.e. could have been in AF for a total of 11 hours. That's well short of the 24 hours threshold you are suggesting.
Results from the TRENDS study, supposedly suggested an AF burden lasting more than 5.5 hours was associated with double risk on embolic events.
I believe there are other studies/trials with other results so what's the answer?
I always remind myself that what might be okay for me might not be okay for others so I normally steer clear of suggesting what others should do. I'm happy to advise what I do but given that we're all different, I generally advise others to discuss with their relevant medical professional taking into consideration their own personal circumstances e.g. medical history, conditions, responses to medications etc. That's what I'll be doing when my CHA2DS2-VASc Score suggests taking AC would be a net benefit for me from a risk perspective - or when compelling evidence arises in the meantime that prompts an earlier discussion.
Hi Achant, i have af approx 35 years and have read everything i can get my hands on and never heard this before.
Anticoagulation is typically recommended when your risk score is two or more. Anything under that the bleed risk may be greater than the stroke risk.
You should also know that beta blockers like bisoprolol are thrown at afib patients like candy and this practice is now being brought under some scrutiny.
I didn't take beta blockers or calcium channel blockers for the first 40 years of my Afib journey. That translated into 40 years living life with no drug limitations or drug side effects. If you're not actually in atrial fibrillation, there may be no real point, other than a doctor feeling they are obligated to do something.
Jim
Would be helpful to share more about your afib diagnosis. When/how diagnosed, how often are episodes, average heart rate, blood pressure, etc.
From your bio, see your first joined 3 years ago. Your doctor is the best source to determine your need for anticoagulants/medications based on your unique circumstances as is done for everyone.
However, the experiences shared here are valuable as you know. The initial onset of afib is the time to be aggressive in treatment. You may want to discuss with your doctor. Best to You !
My consultant referred me to the anticoagulant clinic earlier this year but as I have a score of 1 for being female, the anticoagulant clinic rejected my referral. I’ll see what my consultant says at my next appointment. There are bleeding risks with these medications so it’s a case of weighing up the risks versus benefits, as with all medications.
You only score 1 for being female if you already score at least 1 for something else!
I’ve never heard of that before. I don’t tick any of the other boxes ‘at risk’ boxes. Low everything on the blood tests. The anticoagulant clinic said I was low risk. My cardiologist reckoned risk begins over 60, and not over 65. I’ll see what he says about the anticoagulant clinic rejecting the referral.
Hi Autumn_Leaves,
Baba is right, you no longer score 1 for being female under 65. My cardiothoracic unit at my hospital told me this in September as it had literally just been announced by the Cardiology Society apparently. They’ve also confirmed it in a letter to my GP, but I don’t think the news has filtered through to everyone. My score is now 0 and I’m 58.
If you are 0 it’s likely you do not need an anticoagulant but yes, might be worth asking about it.
I’ll see what the consultant reckons at my next appointment. Calculating risk is difficult because none of us has zero risk of anything, including people without AF. These scoring systems and our individual test results may categorise as low risk, but low risk doesn’t mean no risk. It’s always a risk-benefit equation, with all interventions. My consultant is a very good one and he referred me to the anticoagulation clinic as a first step but they rejected his referral, so I’m curious to find out what he says. I’m also a haematology patient, and that’s the department where the anticoagulant clinic is based, so I have different perspectives. I don’t particularly want to take anticoagulants but I’ve seen some very worrying stories on here about people under 65, so I don’t think it’s wise to be too complacent. On the other hand, there are bleeding risks. So it’s never easy making your own judgment.
I do agree with you. I’m waiting for a second ablation at the moment, after having my first in June and I'm back on warfarin ( it’s long story why it’s warfarin and not a new one). In fact, I’ve hardly been off it this year, due to the ablations, but apart from the regular INR checks, I don’t notice I’m on it and feel more ‘reassured’ when I am on it. It’s best to go with your own judgement definitely, if you can.
It’s not easy. Sometimes there’s an element of having to face up to the reality of our situation. I think that early on we’re all prone to being a bit “in denial” with our diagnosis. You see it in posts who want their first episode of AF to be their only episode. Or we want to somehow make it go away be eating this/not eating that and taking supplements, as if it can all be magicked away by avoiding bread or something. Neither do we to be “one of those people who are on pills for this and pills for that” so there’s also something about our identity shifting when we receive a diagnosis, and it’s understandable that we initially resist it. It’s hard not to let all our emotions overtake our judgment when it comes to our treatment options. If I’m being honest, I wish it would all magically revert to how things used to be, but I also know that’s not realistic. It’s not an easy situation to live with. It is our heart, after all!
I’m the reverse. A virus triggered AF. I was given the minimum dose of Bisoprolol but my heart rate dropped to 40 so I was told to stop taking it. I was also take an anticoagulant daily even though the AF appeared to be a one off, my cardiologist emphasised the risk of a stroke. The downside is I get regular bouts of diahorrea but I can live with that. I was also advised to carry a ‘pill in the pocket’ - a Bisoprolol tablet to take should AF occur again. It did return 15 months after and the tablet worked - nothing since.
Me too re the lowest dose of Bisoprolol. As the surgery didn’t come up with anything else, we consulted a private EP who having introduced me to having a smart phone and Kardia, and having seen the reading I sent him of my heart in AF, sent a prescription for Flecainide to my surgery for me to take as a “pill in the pocket” to take when episodes occurred when it stopped them in a few hours. Now I take it regularly, it has virtually put an end to episodes and I have even managed to reduce the dose slightly. No anticoagulants either with their nasty side effects.
When my GP first suspected PAF he put me on anticoagulants immediately pending a formal diagnosis by a cardiologist.
Am i wrong when i say that it should be an ep that okays anticoagulants, plus at this stage you were only suspected of having af.
He was being cautious and he was correct as things turned out. The anticoagulant was a safeguard against stroke.
I wouldn't be too worried. You're a low risk for stroke, hence no ACrecommended. I was diagnosed 5 years ago and have not commenced AC yet as my CHA₂DS₂-VASc Score is 0 i.e. not yet recommended and it might be years before I meet the criteria for starting AC.
If you have concerns or questions make sure you discuss with your relevant medical professional. They are better positioned to advise you as they will have your full medical background - noting that we're all different.
PS beta blocker is for rate control i.e. used to slow heart rate during AF episodes. You should also discuss rhythm control with your medical professional i.e. medication to prevent or minimise frequency/duration of AF episodes. That usually requires tests to confirm your suitability for any proposed rhythm control medications like flecainide.
As Mjames1 notes, betablockers seem to be prescribed willy nilly after initial AF diagnosis on a starting dose of 2.5mg daily. Until you’ve had an echocardiogram it won’t be clear whether or not the bisoprolol is really necessary to reduce your heart rate.
Much may also depend on how long your episodes of AF last and how often they occur. The anticoagulants are prescribed to prevent clot formation in the heart that then detaches and travels to the brain, causing an ischaemic stroke. However, the general consensus seems to be that if AF doesn’t last for more than a few hours, blood is unlikely to pool in the atrium long enough to form a clot, so if your risk score is otherwise low anticoagulants may place you at greater risk of haemorrhagic stroke (you can do a HAS-BLED score to compare pros and cons with your Chads2Vasc2 score).
Hope that helps. It’s all a question of balancing risks.
Thanks, it does. I haven't started the bisoprolol yet but I'm not very happy to be on beta blockers long term, and my AF episodes are very brief (minutes) so I'd much rather go PIP if possible. They haven't even mentioned a follow-up appointment so it's all a bit confusing at the moment!
During AF episodes my bpm goes up to 200 or so for a matter of minutes. I get a bit breathless, but otherwise the episodes don’t worry me (or the medics) because I’m not suffering from any heart failure. I’ve also learned that it’s taking my bpm above 150 during aerobic exercise that triggers arrhythmia once I relax, so I control my exertion accordingly. The cardiologists prescribe betablockers to avoid longer term restructuring of the heart but in my experience they don’t reduce the frequency or duration of AF episodes.
Biso 1.25mg daily reduced the max heart rate during PAF to 170bpm, but took my resting heart rate down into the 40s. If you only have episodes for a matter of minutes, there’s no point in a PIP (you’ve reverted to NSR before it has kicked in).
You don't mention your age and other medical details that are important in reaching a personal decision. You might find this article of interest. It contains a table that estimates stroke risks as they vary by both AF duration and Chads2 score.
“Pill‐in‐Pocket” anticoagulation for stroke prevention in atrial fibrillation
onlinelibrary.wiley.com/doi...
As for me, I have concerns about intracranial bleeds, so have chosen not to start anticoagulation, even though I am almost 78 with a Chads2 score of 2. However, I do have both flecainide and bisoprolol as PIP medications (ie. use when needed, not daily).
I wasn’t taking any anticoagulants for a few of years whilst still on bisoprolol but after a higher than normal BP reading at a cardiologist appointment he put me straight on anticoagulants because it lifted my chads score. I would rather be on them to be honest.👍
Im on bisop and multaq ,no anticoagulant as chads score 0, have symptomatic paf and even though i am not the biggest fan of long term medications i wish i was on an anticoagulant, so in the meantime i take nattokinase and cayenne pepper in the hope they are protecting me, until ep decides time is right for anticoagulants, i honestly think they should be prescribed as soon as af detected.
The blood issues caused by covid will likely have surfaced by now if there were to be any, and they are very rare. - and anticoagulation likely isn't the way to deal with these - but I wouldn't know. I can understand your being worried, but I think you don't need to be, myself.
AF is quite different and the need for anticoagulation is, from what I can tell, only required if you have other risks - which you don't. I would speak, as others have suggested, to either the clinic or your GP and press for an explanation from them.
Steve
Hi I'm on Bisoprolol 1.25 as 2.5 was too strong I am very sensitive to medication. I'm not on anticoagulants as I'm absolutely terrified of getting the side effects and haven't read any positive reviews only frightening ones. Apart from the bleeding risk all the other side effects are worrying. Unfortunately my symptoms are getting worse and if I want a Cardiac Ablation the Cardiologist won't do it if I'm not on them. It's like a rock and a hard place as it seems so unatural to thin your blood. If you are healthy otherwise and not overweight don't take them if they haven't advised it. GP's are paid to prescribe everyone with a heart condition on them to help the burden on the NHS. Be aware It will take a few weeks for your body to adapt to Bisoprolol. Good luck
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