I have a CHADS2 score of 1 which is down to my age being above 65.
I understand the seven CHADS2 tests which are simple and factual. However, there appears not to be any objective test for the level or severity of AFib.
AFib can be intermittent (PAF), persistent or permanent and in the case of PAF particularly can vary in frequency, severity and duration.
PAF episode frequency and duration can be measured by calculating a burden percentage. Severity to some extent is reflected in the heart rate, although the level of any symptoms is difficult to measure.
My point though is that the CHADS2 test is applied to those diagnosed with AFib as though all AFib sufferers were the same.
I am now on an anti-coagulent and a beta-blocker despite my AFib being very mild. I cannot put my finger on it but something doesn't feel right. But as a risk averse person I couldn't even contemplate changing anything for fear of the consequences.
I suppose this is just Afib messing with my brain but I would welcome any thoughts on this.
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Crimson2020
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keep up with the anticoagulants because Iv read and been told they do reduce our risk of stroke by a good amount. My afib is making itself more popular now unfortunately but I am glad I’m taking my anticoagulants.
Thanks Jetcat, and I too am happy with the anti coagulant. It was more the bisoprolol that I would possibly consider, especially as I had a resting heart rate of 50 before starting the bisoprolol.
You have AF you are at risk. Full stop. You may well have far more AF than you are aware of. Many people are asymptmatic and only discover that they have AF when the stroke hits them.
The amount is irrelevant . The Chads2vasc2 sytem was formulated by Professor Gregory Lip to improve on the orginal CHADS system and none have ever considered AF burden.
I use a Kardia mobile device and a Fitbit watch. Both register AFib when I am experiencing symptoms. They both continue to register AFib for several hours after my symptoms have stopped. Then they register NSR.
I am therefore very interested in your suggestion that I may well have far more AFib than I am aware of.
Only that AF can be asymptomatic (no symptoms.). The country is littered with poor souls who had an AF related stroke who never knew they had AF till the stroke. AF is easily visible on an ECG due to lack of P wave. (~The little lump before the big zig zag) so you obviously do have far more than you think if your machines are telling you when you are not aware.
You are absolutely right that I have more AFib than I am physically aware of. Fortunately 7 hours of every episode is when I am asleep so the Fitbit watch records every minute of this.
That typically leaves 5 to 12 hours the next day when I am in virtually asymptomatic Afib.
I do have an another question though regarding AFib burden.
Is the only measure of AFib burden the percentage time that someone is in AFib?
Or to put it another way, is there any method of expressing the intensity of your AFib symptoms?
Purely time. We are all different and with different levels of acceptance and coping. I never went to A and E at any point and for several years was still race engineering in motorsport AF. My rate seldom went over 200 bpm and with the drugs I was taking I coped. Too many peoeple relied on me! I met an EP once who had AF and told me how one day he went into an episode whilst doing an ablation on a patient. But to say again only time counts when working out AF burden.
That said AF can cause long term damage to the heart if rate is not well controlled ( preferably below 100) I know of people who's rate is below 100 say 80s in permanent AF comtrolled by drugs such as beta blockers because anti-arrhythmics have failed to maintain NSR and they can live long and happy lives.
Me too! I just get on with permanent AF now. Although I have had some iffy blood tests recently, needing further tests. Liver enzymes going up, high serum ferritin. They’ve ruled out genetic haemochromatosis so far. It could be something simple, but my worry is that it might be the apixaban. Just crossing fingers at the moment.
I have damage from covid (long covid - very long!😉) and my liver enzymes & ferritin are always raised so if you've ever had Covid19 you could have a little bit of liver damage and it might be nothing to do with the apixaban. Just a thought - I am not medically trained but have read many recently published papers on long covid to improve my own knowledge. Covid attacked my heart, unfortunately.
It’s a really nasty virus. I have had it twice - fully vaccinated, but of course it doesn’t stop you catching it. Didn’t seem too ill the first time, but the next time I went into AFib, I never came out of it. An ablation planned for a couple of months after that only got me sinus rhythm for 24 hours or so. I was told that there was too much fibrosis for any other ablation or cardioversion to work. Yet up to then I was in AFib just once a month - although it did hang on for days. To be honest, I am doing fine though on a fairly low dose of Bisoprolol. Though I am pretty sure that the Covid infection speeded up my move to permanent AFib.
I did have Covid again in the summer, so it’s a possibility. Also had a hospital stay in February - a middle ear infection set off dreadful sickness and I got a tear in my oesophagus. Dreadful night in A&E etc., four nights total in hospital blood transfusion and two iron infusions. So all of this could play into it. I think the ferritin was checked to see if it was still low, as I’ve never had it checked before as far as I know. Instead of being low it was over 800. Getting an ultrasound next. It’s mainly just GGT that is raised quite a bit - and there is a warning on the Apixaban information leaflet about that. Although another looks like the high end of the range and has increased. I feel relieved that they are taking it seriously and looking into it though.
If you are experiencing increased AF overnight have you tried sleeping 'upright' I now sleep with 4/5 pillows and it has improved massively Lying down definitely seems to have an effect for me
I do not use these machines, but I have heard they are accurate, so I would be tempted to believe them if they say you are in Afib. I was first diagnosed when I was prescribed a drug that made me vomit until I was vomiting flecks of blood -I phoned my GP who was worried about a dissection after the ECG she took showed Afib and a HR of 140. She immediately phoned a Cardiologist to whom I was sent. It took a while to organise a lift as she would not allow me to drive. When I got to the Cardio - three hours later, I was, according to his machines back in NSR (I did have an anti- emetic injection at the GP's). My point is, if your machines are as accurate as I understand them to be, they would, like the Cardiologist's gadgetry show you in NSR at once. He kept me in hospital for the weekend !!
Can I ask ask what model Fitbit you have as mine doesn’t seem to register irregular heartbeat, although I’m told it should. I take my pulse when I feel ectopics and sure enough, irregular…..
I have a Fitbit Charge 6 which only registers AFib when I am asleep. You may need to activate this function. The notification is in the heartbeat section on the app.
It is possible it may register AFib if I remain still but I have never tested this. I may try keeping still for several minutes when I know I am in AFib.
There is also a facilty to take a 30 second ECG on the watch which is done by placing your thumb and finger on the sides of the watch. It gives an instant result of normal HR or AFib with the average bpm. The ECG trace is then available to download on the Fitbit app.
I have a Versa 2, which on its own update a couple of years ago, now detects AF but only when I'm asleep as you need to be still to get a reading. Doesn't have the ecg facility though.
I have paroxysmal Afib and have never had any Afib symptoms - except for the effects of the dronedarone and eliquis I take twice daily. Discovered by annual ECG - my Apple watch and Kardia watch this for me.
The Northwest Medicine REACT-AF study is underway and will try to answer many of the questions in this column….i.e. can a Pill-in-the -Pocket and Apple Watch tailor most Afib prescription scenarios instead of the current one size fits all.
It is not unusual for the symptoms of afib ie in terms of actually feeling what our hearts are doing to diminish over the course of an episode. Towards the end of my episodes ( usually between 9-13 hrs long) I have to take my pulse to see if I am still in afib and sometimes that is hard as the irregularity diminishes as if my heart is trying to go back to NSR. On the other hand I always am aware of exactly when an episode starts if I am awake and if asleep it wakes me up.
It is disputed that the afib burden is irrelevant. That is why there are trials going on to see if PIP anticoagulation is viable for those whose afib burden is low.
l think the anticoagulant is the most important medication. AF is AF however mild. I have been told l have to take an anticoagulant for life, You don’t say what beta-blocker you are taking? The side effects of some beta-blockers are intolerable. I was given Bisoprolol, but couldn’t tolerate it regularly. so use it as. PIP and it works for me. I was wondering if this is why you feel ‘something isn’t right’. There are lots of alternative drugs and it can be trial and error until you find a combination that suits you.
Agree about the AC as I say in my reply to Jetcat. The BB is 2.5mg Bisoprolol daily but it has never given me any problems per se. My issue is that it has reduced my HR from 50 to 45.
Oh, ok got you. Reading your profile l see your HR is relatively low. Is that normal for you? Bisoprolol is a rate control drug so will lower this even more. One of the reasons l can’t take Bisoprolol is because it lowers my blood pressure too much. Personally, l would question this issue of HR with my GP. It’s ok, but doesn’t need to go any lower. I am not a medic, but that’s my opinion. Best wishes.
Yes, I have discussed this with my cardiologist and he said he wants to keep the high end down during my AFib episodes.
I don't have any symptoms of bradycardia and the only concern is that when it drops down to 42 or 43 it tends to trigger an AFib episode.
Edit: In answer to your question, my resting HR was always at 50 before commencing Bisoprolol. Now it is 48 after an AFib episode gradually falling to 43 or 42 after 10 days when I have another episode and it jumps up to 48 and the cycle repeats.
My HR was sub 60 and generally healthy. My cardiologist put me on just Flecainide with no usual Bisoprolol accompanier, as he said it would not improve my QOL. I guess he was not focussed on keeping the HR restricted in an episode as I had only experienced v short term fluctuations above 100 and nothing scary.
I also find when my HR drops during the night AF can kick off. I have had the impression since first diagnosis that I can keep AF at bay all the while I am busy but once I relax 😬.
It seems to me that putting you on an increased dose of Bisoprolol daily is the wrong approach especially if the bradycardia is triggering episodes. It would be far more sensible to take a lower dose of beta blocker daily and up it as soon as an episode starts. This is what my cardiologist told me to do when I said my dose of Nebivolol 1.25mg) was not lowering my heartrate during an episode. Unfortunately the higher dose isn't working either so I am having to go back to see what can be done. That said I don't feel the increased heartbeat very much.
I have only ever been on Bisoprolol 2.5mg daily, so I am not sure if this represents an increased dose.
My cardiologist suggested I miss a tablet if my RHR drops to 45 or 44. I tried this but it didn’t change my RHR or onset of the next episode.
What I do know is that the daily Bisoprolol is significantly reducing the intensity of my symptoms. This is the best outcome as far as I can see, even if it increases the frequency of my episodes.
Back in the day, 6/1/2010 (age 65) - I got up and felt unwell, like going down with flu. Didn't go to work, stayed at home and as the day wore on I noticed my BP falling. End result my BP dropped from around its normal 136/80 ish to 76/50 in a few hours, saw my GP and ended up as quick as a flash in A & E. Long story short ..... diagnosed with paroxysmal AF.
Cardiac Consultant prescribed me Bisoprolol and Warfarin ....... for life. Ablation was discussed at the time but I rejected that, said I'd stay with the medication route. In my write up the Consultant did specifically state ( among other things) that in his view I could be in AF and not know it ........ in other words asymptomatic ......... and it is this statement that has guided me through my AF journey over the years and which (more than anything else) has been the motivating factor in me not messing about with my meds. Don't believe all this new fangled stuff about PIP or AF burden this or that. AF is either paroxysmal, persistent or permanent BUT it is all highly muddled when carrying the real burden of being asymptomatic. Just because you don't feel it (or its symptoms) doesn't mean it isn't having its wicked way with the heart. And that introduces another factor ...... the Vagal Nerve ..... probably a more troublesome feature than is fully given credit for. Not always understood by GP's or Cardiologists but well understood by Gasteroenterologists.
AF is or it isn't, simples............ proof of the pudding is, I'm 80 now and still scoffing me "meds for life". All highly controlled, perhaps an AF event once every 4 or 5 years, but then not real troublesome. Not cured either, just jogging along (not literally) with my Warfarin, Sotalol, Felodopine and Simvastatin. BUT, NO WAY WOULD I EVER CONSIDER MESSING ABOUT WITH MY MEDS. NEVER.
All that misery said .... I have had two surgical procedures and two scans (all different times and different years) - required me to pause Warfarin for a few days and then return to it. No sweat. These days my resting HR is steady at around 67 to 74 bpm. Nice.
So, what do you mean when you say "something doesn't feel right" ??
I’m an OAP, but I still think I’m a young man. I don’t want to be on meds for life, but I want to enjoy good health for many years to come.
And if I am on meds I want evidence. CHADS is evidence based, but there is no real measurement of AFib. This is why I am uncomfortable. There is so little known about AFib and reading scores of posters on this site tells me everyone’s experience of AFib is so different.
Like statins for raised cholesterol, the medical profession doesn’t know the full story. I feel like I was in a 30 year clinical trial for statins and now get the same feeling for AFib medications.
I said earlier it was psychological and AFib really messes with your brain.
But now the wise words from you, John, and Bob and Jet and Cavalier have helped me enormously. Thank you all, and all the others whose posts have helped me.
I still feel something is not quite right but it is where we are. And I am happy that I am in the best place I could be at this moment in time.
Sorry to jump in here but m curious why you feel the need to quantify atrial AF to justify the use of an anticoagulant. Anticoagulants are prescribed based on risk factors that increase the likelihood of clot formation, not necessarily the severity or frequency of AF episodes.
In AF, the atria do not contract effectively, which can lead to blood pooling in a small pouch known as the LAA. When blood isn’t moving properly, it clots. If a clot travels from the heart to the brain, it can block an artery and cause a stroke.
So, the decision to prescribe an anticoagulant isn’t about how fast your heart is beating during AF but rather your overall risk of clotting and stroke.
ForensicFairy, Thanks for your reply and I started to compose a response to why I felt the need to quantify my AF to justify the use of an AC.
Then I read the excellent link that Ozziebob provided a few posts below this one. If you read this you will see that it really does capture my concerns.
There seems to be very little agreement or indeed knowledge as to how long it takes when in afib before clot formation occurs. Or even whether they are temporally associated. I had a very mild TIA six months after the previous afib attack . Was it a result of having afib ? Might I have had it anyway ? For those who have no problems ie side effects with anticoagulants these questions are not that important. For those who do like myself they loom much larger.
Crimson2020 ...... thanks for your thoughts. Well, you are right in a way .... AF is pure, pure mongrel ......... worse .... it is all things to all people ! I've had an easy run in that I found what triggers my AF ....... two things actually. Food and genetics ! Food I dealt with - genetics I can't. Many good folk aren't that lucky.
I should say ... my paternal grandfather died from a series of strokes, 6 in total before he died, each doing different things to the poor old guy. I have an AF diagnosis, a highly controlled burden if you like, and my daughter was diagnosed with AF during both her pregnancies ... once she stopped breeding her AF stopped ........ what happens when she hits 65 plus is a story yet to be told.
So, go figure that little lot. As I say, pure mongrel.
So against that background I have quantified my AF.
Unfortunately, Britain, as in many cases is far behind in terms of AF. I fear in Britain we tend to disregard 'triggers', probably because they are hard to put a finger on. USA websites are far more meaningful in disclosing data on AF.
I tend to agree with you. Everyone is lumped into the same AF pigeon hole for population-level assessments rather than considering a more refined approach based on individual health status.
In my view (but I’m not a medic), the key issue in the individual ischaemic stroke vs bleeding risk balance is the duration and frequency of PAF episodes. As ForensicFairy notes, the theory is that pooling of blood in the atrium can lead to clot formation in the heart; but it’s also hypothesised that in short episodes of PAF (less than 48hrs) blood pooling will likely not be sufficient. Anticoagulants may be advised on an age-related basis; but some 65 or 70 year olds will be a lot more active than others. Antiplatelets (Clopidogrel and Aspirin) that are prescribed by neurologists to mitigate ischaemic clot formation in the small blood vessels of the brain (ie reduce stroke risk) are not considered once someone has an AF diagnosis, whatever the AF burden, and NICE guidelines prevent their prescription. Whilst there is a clear statistical correlation between AF and stroke, I am not aware of any empirical evidence regarding the source of the offending clot (heart or brain).
All of that has led me to prefer low-dose aspirin to DOACs for the time being, despite being 71, because my heart is in good shape (according to echocardiogram), I have a greater bleeding risk on anticoagulants, and my PAF episodes are infrequent and last under 30 mins if and when they occur. But that results from my personal assessment of competing risks; and I may change my tune when I get to 75!
Turning to betablockers, you might want to look at the research studies comparing strict vs lenient rate control. Once I’d had an echocardiogram confirming my heart was physically healthy I decided, after discussion with cardiology, to abandon Bisoprolol altogether in favour of a low dose ACE-inhibitor for blood pressure control. Bisoprolol didn’t reduce the frequency of my occasional PAF; but took my resting heart rate down into the 40s b.p.m. (from 60 b.p.m.) and made me feel like I was exercising with the brakes on at the gym when working out on the rowing machine. I prefer to moderate my own exercise and simply to put up with my infrequent PAF episodes because thus far my heart has always reverted to NSR without any intervention.
I hope these reflections help. Only you can decide what suits you best given your personal health status.
my EP said I only need to take anticoagulant if I go into a-fib for 6 hours or longer. If so, take it for next 30 days straight and if no recorded a-fib, I can go off the anticoagulant unless a new attack happens. I don’t get them regularly and my resting pulse is around 50’s to 60 bpm. not on BP meds because my bp is low normal and pulse and bp went too low when i was put on 12.5mg of Metoprolol XL… halved that to 6.25mg (once a day). They did a 14 day home heart monitor and saw my pulse dipping to 41 bpm so told me to quit bp meds altogether. My EP suggested that I look into Inplant to record my heartbeat for up to 4 ish years, if interested. Haven’t done that, thinking I probably will get that done sometime but can’t afford it at the moment because I have $8000.00 plus doctor’s bill for broken ankle/leg surgery to first get paid off.
That does appear to be a strategy being tried in USA but not one I am comfortable with. Despite not knowlingly having had an AF event for the last 13 years I do not intend to stop my warfarin.
Hi, going by your ep analogy, say you have afib for 7 hours and 4 or 5 times per month, then you need to stay on anticoagulant all of the time, i wont be given anticoag until i turn 65 this year, i never wanted a birthday to come quicker.
You are correct. In my case, so far, I don’t get that frequent or long episodes, usually. I feel it immediately when I get it and hear it in my left ear. I also have devices such as a Kardia Mobile 6L, which is how I initially caught it and sent it to my cardiologist.
I believe mine could very well be due to having Primary Hyperparathyroidism. I am going to have to have surgery to remove bad Parathyroid glands. Unfortunately, doctor’s didn’t diagnose it early enough so I likely will be stuck with a-fib for the rest of my life. I had to eventually do very deep research on my symptoms (online) and self diagnosed it by looking at my labs. I had high calcium for several years and doctors never looked at my Vitamin D or Parathyroid hormones, which would of probably prevented the a-fib from starting in the first place. I am awaiting an Endocrinologist appointment, 1 year waiting list. I started with one Endocrinologist (who agreed that I have Hyperparathyroidism) and she started ordering tests and then left the practice and I had to start over again.
My EP said if it gets worse, I can get the Pulse Ablation, if I want it or just be on anticoagulants permanently, then. She said that I could even get the pulsed ablation now if I choose to. I don’t have that kind of money. I likely will get the loop recorder implanted though, which is quick and done while awake, when I can afford that.
I also have been very fortunate to be able to stop my a-fib by doing Vagal Manaevers, thus far.
Can you request anticoagulants now? Even if you go to a different/private specialist? Or is that too expensive? I hope so, I wish you the very best!
My afib episodes last for an average of 12 hours and now are occurring every 2/3weeks. So such an approach would not suit . However I find the full dose of Apixaban intolerable with various digestive issues and a worsening of joint pain. So I vary the dose. I can tolerate the half dose so I take that. As soon as I go into afib (nearly always in the late evening / early hours ) I take the other half pill and continue on the full dose till my side effect symptoms get intolerable. Then I reduce to 3/4 dose for a few days before resuming the half dose. During the Apixaban clinical trials the half dose was shown to be effective - just not as effective as the full dose. During the time on the half dose I also take a small dose of nattokinase . I also take other supplements that have an anti platelet effect. I cannot say I have noticed any difference in the length of time it takes my blood to clot depending on what dose I am taking. Indeed after a recent colonoscopy when I had been off Apixaban for 3 days I bled copiously for awhile after having a canula removed from my hand. I had previously had the same thing happen while on the full dose just after an episode. After both my hip replacement ops I had post surgical anaemia which I have read can be one of the siddeffects of anticogulants. It was worse after my second op necessitating a transfusion when I had been off Apixaban for a shorter time.
Thank you Auriculaire, thats interesting, how you take anticoagulant and work around the side effects, as i am into weight training i remember an analogy i read years ago, that if you injure your shoulder it shouldnt stop you from training your legs, i also take nattokinase 6000 fu per day , i just wish there was sufficient evidence that it worked the way we hope, as i wont be offered anticoagulant until i turn 65 in may this year.
at 64 I had chads of 2..1 for being a woman and another for bP which is now under control with meds,I asked why wait til I’m 65 to score another point..dr said fair enough do you want anticoagulant now,,yes please.! I wasn’t even sure if there was a system to say happy birthday..you are now 65 chads are 3….so was proactive and asked,
One post earlier mentioned the LAA where blood tends to pool during AF . I’ve recently had a valve replaced during OHS and apparently as a routine procedure the LAA was isolated by clipping . I was told by a senior nurse before surgery that my AF would be much reduced having the clip done but after doing a bit of research it seems it only reduces the possibility of clotting during an episode . After the first few weeks after surgery I was suffering quite a bit of AF but as my heart settled down and I came off Amiodarone the episodes receded and apart from some minor ectopics I’ve not had any AF I’m aware of for nearly 3 months . My HR is around 60 at rest but goes up quickly during exercise and takes a little while to come back down. I’m currently doing a cardio rehab program once a week where I’m monitored during exercise and at the moment the nurses are not happy that my HR is not coming down quickly enough although I’m comfortable during the actual exercise. I’m on 1.25 mg of Bisoprolol daily and I’m wondering if that is part of the issue but it’s obviously having a positive effect on my AF . As for anticoagulants I’m happy to stay on them for life but I’m aware that Edoxaban has no reversal agent for a serious bleed .
Doesn't it take 48hrs plus of being in constant afib,for a clot to form ? as this is the cut off period to have a cardioversion at the a&e, then you have to go on anticoagulants for a month before they will cardiovert you.
I was told by the EP who prescribed Flecainide for me as a PiP that unless episodes of AF went on for a long time, at a high heart rate, I was not at risk of stroke. My episodes hardly ever were and now that I take Flecainide regularly it has virtually put an end to episodes so I am not any more at risk of stroke than I might have been, being 80, according to the box ticking! The first anticoagulant I was prescribed was changed after 3 days as it gave me dreadful diarrhoea and the others caused constipation so I haven’t taken any since and still here at nearly 81!
I was told that a blood clot can form in 20 minutes of AF.As Bob has said,some people are blissfully unaware they have AF until the autopsy. Holter monitors that I have worn in the past for up to 7 days showed events while I was asleep.
I had a Chad's score of 1 for being female. AF was diagnosed in hospital after taken in for norovirus and I asked my GP.if I should be on A/C afterwards. He said no.
I had no really prolonged or highly symptomatic AF. I worked in a rather stressful community teaching job visiting schools all over the county and saw AF as a bit of an annoying nuisance. I had meds as PIPs.
Then I had a TIA the most scary thing ever,away from.home town.
Strangely enough A/C was prescribed immediately and I was asked why I was not on it already.
I feel I dodged a bullet
I think the quantification of severity / burden is largely irrelevant. It takes just one significant AF event to do the damage 💔
As you are a relatively new member, you might like to read this background article which describes the reasons behind the current REACT-AF trial underway in USA on a PIP approach to anticoagulation (results due mid 2029). I will draw your attention particularly to the red/green infilled table which does show stroke risks varying with both your Chads2Vasc2 score and the duration of your AF events.
Although I do understand that with the current frequency of your AF, the trial protocol requirement of 30 days free of AF before stopping anticoagulation would still leave you permanently taking anticoagulants. Here's the article in full ...
“Pill‐in‐Pocket” anticoagulation for stroke prevention in atrial fibrillation
PS. Apple are developing new watch technology that will detect real time AF for volunteers in this trial, and this would eventually (if it works and becomes available on the market) help all patients with detecting previously unknown night time AF events.
PS. Drone01 , AfibSufferer , Mcopt , SkyBluePInk47 might also be interested.
I think the idea of the new Apple watch 24/7 monitoring would be to detect AF (or perhaps an irregular rhythm?), not just a fast heart rate as with some watches (HRV), and to then wake the sleeper to start anticoagulation immediately, not the next day. But I could be wrong and that may not be necessary or possible. Does your Fitbit wake you up? and what exactly does it record to tell you you are in AF?
By the way, I am almost 78, and haven't started my prescribed apixaban yet due to my fears of a repeat of my spontaneous (ie. unexplained) chronic bilateral subdural haematomas in late 2016.
If you Google search "fitbit charge 6 atrial fibrillation" you will get the Google AI response.
It says there will be a notification but I have not got that activated on my watch as there is no action I would want to take. There is though a notification on the app on my iPad which I see when I open the iPad.
It also says it is not intended for those with known AF, but as I said on an earlier reply, I think this is just a legal disclaimer.
The AF report on my app is very detailed giving HR every 0.7 second in 30 minute segments! Each 30 minute segment is summarised with the most recent result.
My most recent was at 06:35 on 30 Dec 2024 which showed a range of 36-133bpm over the 30 minutes. You can then drill down to see the bpm range over 2 minutes and again to see the actual bpm every 0.7 seconds.
Bear in mind that this is all based on the watch light sensor picking up your wrist pulse. It is therefore less reliable than the Kardia Mobile device which is based on the heart's electrical activity.
I am now left with two alternatives. The first is a wonderful quote from Wilsond.
“I think the quantification of severity / burden is largely irrelevant. It takes just one significant AF event to do the damage 💔”
The second is the suggestion of a pill in the pocket trial for anti-coagulation for AFib as per the link on Ozziebob’s post.
The rationale in the AFA article captures my concerns but it needs more evidence. I do see that the article was published over 3 years ago and I guess there is no support for a trial. A cynic may say that the normal funding by big pharma is unlikely.
So I will continue with Edoxaban with reinforced positivity.
I am still okay with Simvastatin and Bisoprolol as I have no side effects but my slight doubts still remain.
That serves me right for suggesting that there would be no funding as it was not in the interests of big pharma.
Out of interest, I spent almost 40 years working for big pharmaceutical companies. We funded no end of research that curiously benefitted our bottom line.🙂
Even now, 12 years into retirement, I believe this was of enormous benefit to millions of sufferers on our medications.
Interesting background. You will be able to make valuable and authoritative contributions to the Posts and Replies on the Forum. Another member Ppiman has mentioned a similar work history in the pharmaceutical industry, and has expressed similar opinions to yours, and is now the Forums "expert" on wearable ecg devices other than watches.
However, while I hear what you say in your final sentence, I am personally struggling with accepting your final summary as I learn more each day about the harmful and criminal behaviours of these companies in the past and which still continue today.
ozziebob I am not sure about authoritative though as I was a money man.
As regards my final sentence I can only speak for my companies. But I can say with some authority that the media are masters of manipulating the truth to suit their agenda (and sell newspapers).
Diagnosed vis GP with PAF and given bisoprolol and blood pressure meds which gave me side effects. Paid privately and saw Cardiologist who told to take bisoprolol as pill in pocket. Take it when needed not daily. BP meds ditched as my BP is low generally. This year other health issues caused my GP to say I had Heart failure - but I decided to see privately a top professor who looked at all my scans and said my heart was fine. The PAF is being triggered and I am looking at causes. Not drinking enough water is one. Eating a large meal at night is another and exertion and breathlessness the most prevalent cause. Prof discovered I have 2 lots of scarring on lungs which may have resulted from covid and would cause breathlessness and in turn AF. Waiting for appt with Chest Clinic June 2025! In meantime controlling with pill in pocket and have increased my hydration levels although I am on Apixiban. Try to drink 2 litres a day of various liquids but avoid alcohol.
Few items of concern:1. Am about to turn 80 and cardiologist indicated he wants to cut my Eliquis in half as that is the standard in Canada.
Any comments from other countries?
2. I have never noticed my AFib but have managed to reduce Bisoprolol to 2.5mg (at night, with cardiologist consent) without impact (HR below 80).
I now have a Galaxy Watch7 and it continuously produces EKG results inDICATING it doesn't know or I may have AFib.
The EKG matches up nicely to what I see on my Kardia (check very infrequently). The blood pressure indicated on my watch also matches up to the one from my monitor (also infrequently).
The sleep analysis also appears very accurate and is summarised each morning.
3. This watch also has a setting to contact someone if you fall down. As I occasionally get dizzy when rising after sitting s long time, this has been comforting.
Many other apps on this watch taking a lot of time to understand.
At 70 in 2019 when I had STROKE - Embolic, rapid & persistent AF and diagnosed with thyroid cancer.
My triage team containing an Endocrologist prescribed me 110 PRADAXA x twice day. The top dose is 150mg PRADAXA x twice.
It reads in the blurn inside box reduce at 80. But my Locum Dr who has had AF and underwent an ablation in Australia was keen that I stay on 110mg x twice.
Also I read if you have cancer you should not have any dose of anti-co.agulant.
Now almost 76 with a ? of thyroid cancer return because of calcification I am glad of the 110mg.
Yes at 80 you should have a reduction in it. May be because of likelihood of falls.
Crimson, your cardiologist is correct in that the kardia may pick up PAF as it may not be present at the time of taking an ECG. A 24hr ECG is good, but not practical 24/7 . The main thing is that you have a diagnosis and getting treatment.
Are you aware of the Wellue ecg devices that will record continuous ecgs for either up to 24 hours, or up to 72 hours (2 different models). Patients either wear a chest strap or the usually more reliable 2 chest electrodes. I can provide links if you can't locate these online, but I own neither, as you need a laptop to make best use of the AI based reports produced by the supplied software, and, as of 2025, my only device is a phone.🤔 And to think I have a degree in Computer Science and worked in the industry for many years !!!
I have worked in tech industry until I retired. Always had a computer but last couple of years only seem to use my smartphone. But recently added a Samsung Galaxy Watch7 for health reasons (BP, HR, sleep analysis, ECG, AFib, falling down, etc).
At least I did have the insight that phones would be able to perform the functions of small computers before the general public thought the same. But I am strongly Aquarian.🤔
But I really could do with more processing power and speed than my 2018 mid range Android 9 Motorola phone. Did I mention I also have the frugal ways of my older generation.🤔
Yes, however, I'm trying not to join the Apple cult. And I'm waiting for the Pixel 10 which promises(?) a big jump in processing power over the current 9. I like the 7 years of updates with the Pixel and the absence of bloatware in Google phones, plus the direct support from Google.
Sadly, you need a desktop or laptop computer to get best use of the Wellue 24/72 hour ecg devices, and that continues to thwart me from buying this covered device. I'm hoping an App based device will eventually enter the market that does similar AI processing as the current Wellue ecg device with supplied software.
My tech choices have been made less "disrupted" and easier by the fact that I don't have a wife to "nudge" me into wider considerations. Not that I enjoy my marital status. But it is what it is.
Not sure I understand your words ... "The ECG is automatic". Surely not. Surely you have to make a second connection with a finger on your other hand to initiate an ecg?
And what is the duration of the ecg shown? Usually watches can only return the determination "irregular heart rhythm detected" based on heart rate variability (HRV) during the night, as they have no ability to record ecgs while you are sleeping.
I have similarities to your situation with a Chadvas score of 1 due to age and PAF. After my initial Afib episode 2 years ago I was put on Anticoagulant and Betablocker. After 5 months with no further episodes EP took me off both. Following 2 further episodes a month apart I went back on the BB and for a month the anticoagulant. I then took the anticoagulant as a pill in the pocket taking it for 30 days when an afib episode started and then stopping. Earlier last year I was getting monthly episodes of Afib so I was then permanently on the anticoagulant. I had an ablation in August and have had no Afib episodes since then. At my 3 month review in November my EP was fairly clear that I didn't need to be on any medications. So I have stopped the Betablocker however I was a bit more anxious about discontinuing the anticoagulant so I am on it until the end of February and if no more episodes will discontinue then. My understanding is that with a chadvas score of 1 the risks from stroke without anticoagulant is fairly similar to the risk of a major bleed with anticoagulant, either of which can be fatal. So the various Afib stroke guidelines do not say yes or no to anticoagulant when the score is 1 rather it's a decision to be agreed between the patient and doctor based on individual patient circumstances. The EPs reasoning in my case was that the afib burden is negligible/low therefore my risk from stroke would be at the low end of people with a score of 1. Add to that , that I am a cyclist and a hillwalker with possible risks of falls then it tips the balance of risk away from using anticoagulant. My afib has always been highly symptomatic and the EP indicated that should it return then it would return as symptomatic. So my intention is to stop the anticoagulant but retain a supply if I should experience another episode. My EP was positive about my prognosis telling me one of the negatives about Afib is it how it can keep healthy people feeling that they are unhealthy. I am probably not so optimistic as he is but nevertheless am inclined to follow his advice provided that there is a good rationale.
You might be interested in looking at the red-green infilled stroke risk table in the Wiley article I mentioned above. While it unfortunately doesn't address major bleed risks, it does cover stroke risks for all Chads2 scores beginning at 0.
Thanks Bob I was aware of the REACT trial though hadn't seen this article which is very informative and is personally reassuring in how it aligns with the view taken by my EP. The statement that there is a clear step-up in risk as one moves from paroxysmal to persistent to permanent AF is intuitively what I would expect however from reading articles etc on AF stroke risk this is generally not the position taken. For me an expectation from a specialist is that they should be able to form a judgement on the best approach for each individual based on their presentation rather than simply applying guidelines which are based on averages across whole populations.
I'm late to the party and maybe this was mentioned already. My cardiologist says the greatest risk of stroke is at the moment the heart converts out of AF.
I am avoiding any beta-blockers as long as I can, although that comes up in conversation. I have too many of the adverse effects already. I may have to go with a pacemaker which also comes up in my appointments.
I'm curious about whether a Holter monitor has shed any light on just how much AF you have.
Sounds good! I'm sure they are good docs... but I think, especially if you were to get to the point that you might need an afib ablation procedure, that maybe you consider seeing an Electrophysiologist who has good experience with afib and afib ablations before making those decisions? EP's are the true specialists for Afib, and they have the ultimate insight into everything afib, so many times we get more valuable info from them than Cardiologists and especially GP's... who often don't have the time to stay up on current tech on afib. Just a thought, afib is pretty different and much more nuanced than many other heart issues!
The bisoprolol is for rate control. I thought that CHADS2 and CHADS2VASc were solely for AFib so I wouldn't score any points for having AFib.
My only score is 1 for being over 65.
My Fitbit clearly shows a drop in resting heart rate from 50 to 44 after commencing bisoprolol. My Kardia Mobile also shows a similar fall in HR when I am at rest.
My average HR during Afib is down from about 120 to 80.
Goodness I found 51 brought down CCB was too low. 44 too low during the Day.
See if you can try one of the CCBs and they start at 30mg. Perhaps you can have PIP. CCBs dont bring down the BP much. At your age BP 100 plus your age is OK.
Control of H/R is 100 or less.
Seems to me you need a review when taking Bisoprolol which saps your energy.
Joy, thank you for your replies. I like to hear a broad range of opinions.
However as it stands at the moment, I am feeling 100%. It would be odd to change my medication when everything is fine.
If there was any suggestion that a resting heart rate of 44bpm was dangerous I might revisit this issue. But my cardiologist is fine with this, saying that a RHR in the 30’s may be a problem.
Before commencing Bisoprolol, my resting heart rate (RHR) was 50 bpm. My typical average heart rate during an AFib episode during a 30 second ECG on my Kardia was 120bpm.
Now, on Bisoprolol, my RHR is low 40's and my typical average 30 second HR during AFib is 80bpm.
Your 2 main points are spot on - stick to point 1. You need to perform tests to see how much plaque is narrowing your blood flow in your blood vessels. There are 3-6 common procedures you can get done. We should add Heart attacks to your Discussions as these are mainly caused by excessive plaque built up. There are lots of medicines to control high pulse rates and lots of medicines to prevent the growth of blood clots.My Mum took Amiodarone for 19 yrs without AF and statins-SHE DIED FROM A HEART ATTACK- She had normal cholesterol during that time. What do formulas mean now- ZILCH.
A friend's husband was diagnosed with AF about a year ago and despite having a zero Chads score was put on Anticoagulants.
He died of a severe stroke recently.
It was haemorrhagic - a brain bleed.
The formula is there for good reason; it's a method of weighing up the risk versus benefit of deliberately inhibiting the blood's ability to clot.
In my opinion this gentleman was prescribed medication contrary to the accepted guidelines and I remarked to his wife that she really ought to be making a formal complaint to NICE etc.
On this forum I see a lot of posts pushing the idea that anyone who has AF should be on ACs regardless of age, co-morbitities or lack thereof.
As evidenced by the case described, this is a misguided and potentially life-threatening dogma.
I am almost 78 (Chads2 & Hasbled both = 2) and have refused to start the apixaban I was advised for my paroxysmal AF despite NHS awareness of my spontaneous chronic bilateral subdural haematomas when I was aged 70. Treatment of patients by medics is always in consultation and agreement of the individual patient. My choice was accepted by the young haematology pharmacist giving me their recommendation, with the pharmacist then offering generalised information about the stroke risks I would now incur. But I have never been able to discuss my decision or my reasons fully with any cardiologist or EP or Haematologist or GP. I am still disappointed in this lack of consultation with any senior medical experts, but am still happy with my choice which I keep under review by reading ongoing research on stroke and bleed risks for the DOACs. But I still have no idea if my choice will ultimately prove my saviour or my undoing. 🤔
I am sad to hear about your friend's husband's demise. It is often very difficult to go against what you think should be the best medical advice for your individual situation.
Sounds like on your records that they have noted no anti co.agulants
Once that is on your file it should not be open gor debate. If you want open discussion have this changed to -"would like discussion with cardiologist etc."
According to the definition of an intercranial bleed is that is covers a very low % and usually happens in those under 30 following a head knock.
Description is that a weakened blood vessel has burst within the skull. No mention that an anti-co.agulant has caused it.
I chose PRADAXA as it is taken twice a day. My thoughts were if taken once a day a big amount is delivered all at one time. Also there is a reversal med if it is needed At the time of the stroke - embolic I was prescribed a lower dose of 110mg and I was 70 years.
I have never had any problems and been through 3 operations following guidelines.
Even during the 3 different operations, not heart ,and having AF ,no excessive bleeding was noted.
Researchers say that if you have any form of cancer, you should not be taking it.
Blaming an anti-co.agulant unless proven is confusing for others.
I'm sure Anticoagulation is right for you and indeed for the vast majority of those prescribed it.
I'm also fully aware that the majority of strokes are caused by clots and that a smaller percentage are down to brain bleeds.
However the deceased was prescribed AC contrary to the accepted guidance. It is a simple fact that taking AC increases your risk of haemorrhagic stroke, which is why the Chads and Hasbled scores exist - to identify the point at which, statistically, the risk of clot stroke outweighs that of bleed stroke.
Brain bleeds can also be put down to high BP. Also high cholesterol.
An embolism is described that a clot was formed outside the brain. Except although they thought my CT scan would show it at the back of my head. That was proven wring when it shows the spot in my left frontal lobe.
The carotid arteries were clear of anything like plague or cholesterol.
All interesting.
The Dr an endocrinologist went against my wishes in prescribing BB Metoprolol. It was later proved to make me breathless without exert of a H/R of 186. Also pauses at night. With my normal low 47avg bpm.
I also fought against this same Dr not to have RAI treatment post thyroidectomy and TSH suppression.
I stay under my surgeon who reminded her to respect my wishes.
My PRADAXA was changed within the final discharge from my local hospital after my transfer - to 150mg. You can imagine how outraged I was. A foreign Dr decided I should have the higher dose. Under protest from my then Loctum Dr who did change it back but she had to write on each prescription that "this patient demands the 110mg dose".
Along the way one cardiologist scolded me for not taking my PRADAXA. I said I had. I later proved that missing 3 months supply was actually given out but not registered.
Anticoagulants might not cause brain bleeds, but such bleeds will last longer if the patient is anticoagulated, and this is often the factor that makes them catastrophic.
Also, many elderly patients, including those with AF, live alone, so the extra possibility exists that if such a bleed occurred at home while anticoagulated, then the patient could well become incapacitated before being able to obtain the assistance needed to travel to hospital for the reversal agent within the specified time period. Just saying. And these are my concerns too.
But I awoke at 2am at stroke time with a splitting head. I don't get headaches.
I wandered to the loo and as I was sooo tired went back to bed. Then I reawoke at 5am. This time didn't make loo. I showered and then looked in the mirror. I had dropsy, face dropped and couldnt drink or eat, or talk properly. Only the home phone put me where I lived.
We had to wait for the helicopter and during the wind and rain, it stopped off at BOI Kerikeri to fill up before we landed iat the roof of Whangarei hospital.
You seem to have been fortunate in having someone to help you contact medical services. "We had to wait for the helicopter ..."?
My first sign of my bleed was intermittent paralysis of my left hand for short periods, and I was able at that time to cycle to the hospital by myself. But I wasn't anticoagulated at that time and the chronic bleeding had stopped by itself by the time I reached hospital, although later scans did show frighteningly large pools of blood across both hemispheres of my brain. So I was lucky as well.
Our 111 could not pick up my home address by my 2G cell. But I also have a home phone that did.
I was not on any meds.
The team asked me if I had rung from the cell I culd say yes.
Otherwise I would have walked up the road and knocked on door. Also I had joined St John via membership a month prior so I did not need to pay towards the helicopter.
Now I have a home alarm with pendant.
cheri JOY
Our local St John head quarters is just up the road on St Johns RD.
We, was the Ambulance staff arrived at my place but I was driven to the Taipa Beach which has a big grassy area to land. I had no one except my dog.
As the Co pilot said he felt sick coming up, we all got a jab os anti-sickless!
Then there was the missing tablet left in the ambulance which had left. Another say 20 minutes trying to find it.
Rural. I'm not rural on the East Coast. All the communities with our beaches.
Drs well we have one who works 2-3 days week, a Locum and woyhout her we have a practice Nurse who diagnosed my 81 year old friend with an UTI. I diagnosed her with cryptogenic organizing pneumonia. She had the latter.
Not enough older trained Drs up here.
But I can remember as a 1st year nurse I had 32 beds to make in 1/2 hour with a community nurse. 1966.
My surgeon who has been with our base hospital for more than 20 years, has retired and gone to UK.
As we can get into Australia and work easily. Our trained Drs go there. But they have asset testing for all sorts of services.
Our nurses are striking for more equal pay like Australia,
Our hospitals no longer say "you are out of our area' which I got although no surgery of 'removing the Johnson & Johnson rough mesh doing damage. Hospitals deceased having areas so when my gynae-uro special exclaimed its through I got called up immediately but had to wait for the 3D Scan in January. Done in early March.
You are brave not having an anti-co.agulant but risk is there both ways. I find PRADAXA 110mg x twice an intermediate risk.
You can go the other way by eating the foods like greens and more greens etc.
This thread is going a bit off-topic so I thought I would post an extract from the medical article provided in a link by ozziebob.
This does validate my concerns that there appear not to be any objective tests for the level or severity of AFib before recommending anti-coagulents.
"Medicine is not “one size fits all.” Indeed, there are few examples when all patients with a history of a disease are treated with the same doses of the same medications without regard to disease burden, comorbidities, or efficacy of treatment.
An exception is our current approach to stroke prevention in atrial fibrillation (AF), as chronic anticoagulation is recommended for nearly all patients with clinically detected AF and other vascular risk factors, regardless of the number of risk factors, burden of AF, or history of successful intervention.
For many, this translates into a lifetime of exposure to the risks and costs of anticoagulation therapy, sometimes with questionable benefit."
You're right though - in terms of AC prescription, there is largely no distinction made between a patient who has two five-minute bouts of AF per year and one in permanent AF.
The thinking generally seems to be that of you have AF and fit the Chads criteria, you should be on ACs regardless of the severity or regularity of your individual condition.
I was diagnosed with PAF in 2021 the frequency has slightly increased over the years and I do have high rate AF a few times a year which has resulted in three cardio versions. I am 56 and have been on Edoxaban since 2021. I attended my AF clinic recently to discuss Ablation. As part of the discussion they reviewed the Edoxaban usage and as my Chads is 0 I have been taken off it. I have been informed that they will prescribe 300mg of Flecainide instead of cardioversion which will be administered in hospital if the Bisoprolol pill in the the pocket does not work. I raised the issue if I was not on anti coagulant and the Flecainide did not work where did I stand with cardioversion I was told there was an option to inject an anti coagulant via the stomach. I was told the risk of stroke via a bleed was higher as I had no co morbidities and the echo showed no structural issue. Just need to work on dropping my BMi. I was a little reluctant to be off it at first, but it actually feels liberating no longer to be on it, although I accept that at some point I may have to return to taking it if/when things change.
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