Millions of people have it. But it tends to take a long time to get diagnosed. In the meantime, many are unaware of the toll it’s taking on their health. That is until it causes congestive heart failure or a stroke.
We’re talking about atrial fibrillation, the most common type of irregular heartbeat. Sherry Saxonhouse, MD, director of Atrium Health Sanger Heart & Vascular Institute Atrial Fibrillation Center of Excellence, describes it as a global health crisis that affects over 37 million people around the world.
“The lifetime risk of developing atrial fibrillation is around 25%,” revealed Dr. Saxonhouse. “Patients with atrial fibrillation have 5 times the risk of having a stroke than those without it. Having a fast heartbeat for an extended period can overwork your heart and cause it to weaken, eventually leading to congestive heart failure.”
Managing atrial fibrillation can be very challenging since patients usually have comorbidities, which are other conditions or risk factors that aggravate their heart condition. These comorbidities include diabetes, high blood pressure and sleep apnea.
Sanger Heart & Vascular Institute launched its Atrial Fibrillation Center of Excellence to provide holistic care for patients with atrial fibrillation. The center has been specially designed to screen patients for risk factors and provide seamless coordination between care teams, ensuring personalized, timely treatment.
“When a patient used to see a specialist for a condition, the specialist would address a portion of their health,” explains Satish Misra, MD, electrophysiologist at Sanger Heart & Vascular Institute Atrial Fibrillation Center of Excellence. “Beyond just fixing a narrow health problem, our specialists are trained to examine each patient’s overall health and well-being, looking for opportunities to improve their quality of life. After carefully screening patients for risk factors, we connect them with the right providers and resources.”
“We don’t just treat the disease, we treat the patient,” added Dr. Saxonhouse. “Every patient has a different story and a different set of risk factors. When we work together to determine the best course of treatment for the individual, we see better outcomes.”
Dr. Saxonhouse and Dr. Misra answer common questions about atrial fibrillation, providing insights on triggers, symptoms, diagnosis and treatment.
What are the most common triggers for atrial fibrillation?
Dr. Saxonhouse: Atrial fibrillation is most commonly caused by:
- Alcohol
- Excessive caffeine consumption, which for some is more than 1 cup of caffeine per day
- Dehydration, which can be caused by consuming alcohol or caffeine
- A lack of sleep or untreated obstructive sleep apnea
- Smoking
- Other uncontrolled health conditions (e.g., hypertension, diabetes and congestive heart failure)
What are the most common symptoms?
Dr. Misra: Patients with atrial fibrillation may experience the following:
- A skipped heartbeat or a racing heartbeat
- Heart palpitations (a fluttering or pounding sensation in the chest)
- Shortness of breath
- Fatigue
- Difficulty with daily activities and exertion
- Cognitive impairment (brain fog)
- Exercise intolerance
- Dizziness and lightheadedness
How is atrial fibrillation diagnosed?
Dr. Misra: Your doctor will use an electrocardiogram to diagnose atrial fibrillation. This test measures your heart’s electrical activity. While this test can be performed in the office, there are also options for recording your heart rhythm at home – either through wearable monitors or smartphone-connected electrocardiogram devices.
How is atrial fibrillation treated?
Dr. Saxonhouse: Treatment for atrial fibrillation may include the following:
- Medication: Depending on your symptoms, your doctor may prescribe medication that slows down your heart rate or keeps your heart in a normal rhythm. Medication is usually prescribed along with other treatments.
- Ablation: This treatment isolates and removes the short circuits (irregular electrical signals) from the left upper chamber of the heart that causes atrial fibrillation. Following ablation, most patients live without atrial fibrillation. A small percentage of patients may only have short episodes each year. The treatment is proven to improve quality of life, decrease hospitalization, decrease episodes of heart failure and decrease mortality (death). Ablation is performed under anesthesia using catheters that are inserted into the body through IVs placed in the patient’s groin. This is an extremely common procedure. At Sanger, we perform close to 1,000 ablations procedures for atrial fibrillation each year. Following ablation, patients have about 4 hours of bedrest and then return home the same day.
For patients at risk for stroke based on comorbidities, blood thinners may be prescribed in parallel with the above treatments.
What outcomes can patients typically expect following treatment?
Some patients with atrial fibrillation need long-term blood thinners to prevent stroke. For example, many patients who have an ablation can return to normal activities and stop taking the medications that were needed to regulate their heartbeat prior to the procedure. Older patients who had a stroke and/or diabetes may still need to be on long-term blood thinners after ablation. Risk factors that increase stroke in patients with atrial fibrillation include:
- Patients over age 65 are at increased risk.
- Women have a higher risk than men.
- Other conditions. High blood pressure, diabetes, congestive heart failure, prior stroke, valvular heart disease and prior heart attacks increase your risk.
How can patients prevent atrial fibrillation?
Dr. Misra: Patients can prevent atrial fibrillation by managing other medical conditions and lifestyle factors that are known to promote abnormal heart rhythms. To keep your heart in normal rhythm, we recommend:
- Doing moderate exercise. While we typically recommend 150 minutes of aerobic exercise per week, remember that any exercise is better than none.
- Staying well-hydrated. Dehydration is one of the most common triggers for atrial fibrillation.
- Treating sleep apnea. Symptoms such as snoring or feeling sleepy during the day can be signs of sleep apnea. If you have this condition, treating it can help prevent atrial fibrillation.
- Reducing alcohol consumption. Since alcohol is a common trigger for atrial fibrillation, avoiding it can help reduce recurrence.
- Managing chronic conditions. Conditions like high blood pressure and diabetes are closely tied to your risk of atrial fibrillation. Working with your primary care doctor to control these conditions can help reduce your future risk of atrial fibrillation.
How is Sanger Heart & Vascular Institute Atrial Fibrillation Center of Excellence providing outstanding care for patients with atrial fibrillation?
Dr. Saxonhouse: We designed the center to provide patient-centered care as outlined below:
- Risk factor screening: We prescreen all patients with atrial fibrillation for risk factors. Then, we connect them with the care they need. For example, we refer patients with obstructive sleep apnea to Atrium Health Sleep Medicine.
- Nurse navigation: We connect each patient with a nurse navigator to support them before, during and after their ablation procedure. This ensures that patients receive coordinated care and stay well-informed throughout the entire process.
- Clinical coordination: In the clinic, we provide an outstanding patient experience by coordinating their care with our providers, including our specialized electrophysiology nurses, advanced providers (nurse practitioners and physician assistants) and physicians.
- Standardizing care for patients with atrial fibrillation through guideline-directed pathways: We have created 4 separate treatment pathways for those seen by the emergency department, admitted to the hospital, seen by outpatient doctors or going through open-heart surgery. Each pathway establishes standard treatment protocols, providing consistent, timely and efficient care at all our facilities. Our quality teams carefully monitor all pathways to ensure they are being implemented properly and improving care. For example, the pathways should help decrease hospitalizations, decrease readmissions and reduce the length of hospital stays.
Why is patient education important? What education opportunities are available?
Dr. Misra: The time we get to spend with patients during clinical visits reflects a small percentage of time in the patient’s life. Much of what we ask them to do happens outside of those visits, including exercising, changing diet, managing medications and ensuring appropriate care of other conditions. Beyond that, the patient needs to be focused on lifestyle modifications and risk factor management. To be successful, we partner with our patients to help them set goals and empower them with the knowledge to understand why these goals matter and what it takes to successfully achieve them.
Since people absorb information in so many ways, we feel it’s important to meet our patients where they are. We offer patient education in a variety of formats, including printed materials and on-demand videos. Some patients learn the most during one-on-one conversations with their physicians, advanced practice providers and nurse navigators, which is why many of our visits are focused on education. Later this summer, we’ll be starting virtual group classes. Each month, these interactive classes will focus on different topics related to atrial fibrillation care.
Our hope is that by delivering this crucial information in multiple formats and at different times, we can give all of our patients the necessary tools to effectively manage their atrial fibrillation.
Learn more about Sanger’s heart rhythm care. A team of experts offers dedicated care for atrial fibrillation, combining clinical experience with expertise in the latest technology.
