Watch Dr. Isaac George present research publications pertinent to the impact of AF on the health and wellbeing of patient populations with regard to mortality, stroke, SCI’s and bleeding.
For the hearing impaired members of the AFibSurgeons.org community, we have provided a written transcript below:
Isaac George: Normal sinus rhythm is better than atrial fibrillation. Atrial fibrillation impacts mortality. We have excellent data that suggests this and shows this.
When we look at patient population studies as shown on the left side, across all age groups, we can see that patients with atrial fibrillation don’t live as long. Mortality is 20% higher in matched patients with atrial fibrillation irrespective of age. These curves, as you can see, diverge over time. They have profound effects on ventricular function.
There is bleeding complications that occur because of anticoagulation. There are higher rates of stroke that occur with atrial fibrillation. These lead to increased hospital costs as well as higher hospital readmissions and admissions. This is followed up with confirmatory studies such as one from the Framingham Heart Study in over 600 patients with atrial fibrillation compared to those who didn’t have atrial fibrillation across a wide range of ages. You can see that mortality was increased almost two-fold independent of sex again with follow-up out to ten years.
Atrial fibrillation is a balance. Treating atrial fibrillation can mean the difference between stroke or bleeding. The stroke risks per year depending on your CHADSVAS score can range from 0 up to 15% depending on the number of risk factors that you have again as determined by your CHADSVAS score.
However, treating patients with atrial fibrillation to prevent stroke requires anticoagulation. This can be quantified by the HAS-BLED score. You can see that the total number of bleeds per 100 patient-years can be significant. I think we all know patients that have had bleeding complications from chronic systemic anticoagulation. That’s the tradeoff.
In addition, patients can suffer silent cerebral infractions or ischemia. This is the untold story of atrial fibrillation. Numerous studies have documented that in atrial fibrillation, patients who have asymptomatic strokes can suffer cognitive decline over time despite anticoagulation. This can occur in the presence of paroxysmal, persistent AF independent of duration of therapy.
Postoperative atrial fibrillation after open-heart surgery is not benign either. In a recent study of over 9,000 patients who underwent CABG, postoperative atrial fibrillation was present in over 30% of patients. It was associated with long-term mortality.
The risk of stroke had an odds ratio of anywhere from 1.7 to 1.8. You can see here that long-term survival out to nine to ten years was significantly reduced in patients who had persistent as well as postoperative atrial fibrillation. This is again independent of sex. As you can see, the red and blue lines denote male and female sex.