PCPs on the front line for atrial fibrillation

Atrial fibrillation causes one sixth of strokes in the United States.
Atrial fibrillation causes one sixth of strokes in the United States.
Diagnosing atrial fibrillation (AF) could sharply reduce strokes in the United States, and primary-care providers (PCPs) have a key role to play, according to experts affiliated with the American College of Cardiology (ACC).

“Patients may often be asymptomatic,” Michael Ezekowitz, MD, PhD, vice president of clinical research at Main Line Hospitals in Wynnewood, Pa. explains. “They report no chest pain, no palpitations, no shortness of breath. They do feel fatigued, but they think that's just part of getting older. Unfortunately, they tend to present with unexplained stroke.”

AF causes about one sixth of strokes in the United States. “These strokes tend to be more severe and disabling than strokes not associated with AF and are twice as likely to be fatal,” adds Donald T. Lackland, DPH, a professor of cardiology at the Medical University of South Carolina in Charleston. “On the other hand, 60% of these strokes are potentially preventable by recognizing and treating AF.”

The two physicians presented an update on AF prevalence and treatment at the recent ACC scientific meeting in Orlando.

“PCPs must recognize the importance of AF,” Dr. Lackland urges. “They have more exposure to patients than cardiologists, so they need to do assessments” with ECGs or feeling the pulse to measure rhythms.

The next step is treatment. “Anticoagulant therapy is much better than antiplatelet, but the therapy is difficult,” advises Dr. Ezekowitz. Part of the choice between anti-coagulants and antiplatelets, such as aspirin and clopidogrel, is determined by other risk factors. “Antiplatelets may be used in low-risk patients or those with contraindications to oral anticoagulation, but they're not as effective,” he states.

Dr. Ezekowitz recommends the CHADS2 risk score (Congestive heart failure, Hypertension, Age >75 years, Diabetes, and previous Stroke) to determine therapy.
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