Heart rhythm problems are best managed when patients are listened to

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Atrial fibrillation is the most common heart rhythm disorder and increases the risk of stroke by fivefold.

In a new study, researchers suggest patients with irregular heartbeats should choose the treatment plan with their health professionals.

The research was conducted by a team at the European Society of Cardiology and elsewhere.

It is estimated that one in three Europeans will develop atrial fibrillation. It is linked to a twofold increased risk of death in women and a 1.5-fold increase in men.

People with atrial fibrillation are twice as likely to be admitted to the hospital as their peers without the condition.

Symptoms include palpitations, shortness of breath, fatigue, and difficulty sleeping. Up to one in five patients are depressed.

More than 60% of patients report significantly impaired quality of life, while cognitive decline and dementia are around 50% more likely than in the general population.

The guidelines advocate the Atrial fibrillation Better Care (ABC) pathway.

‘A’ (Anticoagulation/Avoid stroke) involves anticoagulation medication to prevent stroke except in patients at low risk.

‘B’ (Better symptom management) refers to controlling heart rate and heart rhythm with medications and procedures.

‘C’ (Cardiovascular and Comorbidity optimization) is the management of other conditions such as high blood pressure and lifestyle—for example smoking cessation, improved nutrition to lose weight, avoiding excess alcohol, and moderate-intensity exercise.

A care plan should be agreed after patients and their families discuss the advantages and limitations of each treatment option with an interdisciplinary team including cardiologists, nurses, and psychologists.

The success of treatment from the patient’s perspective should be assessed by routinely collecting information on the quality of life, symptoms, cognitive function, and the ability to work and be physically active.

Prevention of stroke is a vital part of treatment.

Atrial fibrillation is one of the most frequent heart rhythm disorders during pregnancy—especially in older women and those born with heart defects—and is associated with an increased risk of death.

Vaginal delivery is contraindicated in women taking warfarin because of bleeding risks for the baby. The use of non-vitamin K antagonist oral anticoagulants (NOACs) is prohibited during pregnancy.

Athletes are around five times more likely to develop atrial fibrillation during their lifetime compared to sedentary individuals.

Endurance sports such as running, cycling, and cross-country skiing carry the highest risk. Professional athletes should be advised that long-lasting intense sports participation may promote atrial fibrillation.

Contact sports should be avoided in patients on oral anticoagulants due to the risks of bleeding.

Screening could identify people with previously undiagnosed atrial fibrillation who could then receive treatment to prevent stroke.

More than 100,000 apps for smartphones, wrist bands, and watches and at least 400 wearable activity monitors are available—but the guidelines state that caution is needed as many are not clinically validated to detect atrial fibrillation.

Opportunistic screening is advised for people aged 65 and over and for people with high blood pressure, who should have their pulse taken or undergo an electrocardiogram (ECG).

People should be informed about the treatment implications of detecting atrial fibrillation. Those who test positive should be referred to a physician to confirm the diagnosis.

The team says people with unhealthy lifestyles are more likely to develop atrial fibrillation.

Risk can be reduced by lifestyle modification—for example, weight control, and moderate physical activity.

One author of the study is Professor Gerhard Hindricks.

The study is published in European Heart Journal.

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