Atrial fibrillation – more than just some palpitations

Forty-five per cent of patients admitted to hospital for atrial fibrillation (AF) in Australia and New Zealand die within a decade, a research team based at The Prince Charles Hospital (TPCH) has found.

TPCH Resident Medical Officer Dr Linh Ngo said AF was the most common heart rhythm disorder and the leading cause of heart-related hospitalisations globally, causing symptoms like palpitations, dizziness and chest pain.

“The disorder is associated with increased risk of stroke, but we know much less about the risk of recurrent hospitalisations and other consequences such as heart failure or death,” Dr Ngo said.

As part of her PhD project, Dr Ngo led a study analysing data from more than 250,000 patients admitted for AF and atrial flutter — a closely related condition — to all public and most private hospitals in Australia and New Zealand between 2008 and 2017 to fill in this knowledge gap.

“Unfortunately, we found only 55.2 per cent of patients hospitalised for atrial fibrillation survived beyond a decade,” Dr Ngo said.

While some of those deaths were attributable to coexisting conditions, Dr Ngo said the research showed AF reduced a patient’s life expectancy on average by 2.6 years when compared with the general population, suggesting a significant burden on long-term survival.

“Furthermore, at 10 years, one in 10 patients had suffered a stroke, one in six were hospitalised for heart failure and about four in 10 had been readmitted due to recurrent atrial fibrillation or flutter,” Dr Ngo said.

The research revealed that at 10 years, less than seven per cent of patients had catheter ablation procedure, one of the most effective treatments for patients with symptomatic AF.

“It may mean this procedure was underused in Australian and New Zealand hospitals,” she said.

“We think that the high cost and long wait times in the public system are potential barriers to more widespread utilisation of this effective treatment for AF.

“Clinicians currently primarily focus on preventing the risk of stroke, but these findings emphasise the need to consider atrial fibrillation as a chronic disease with multiple serious downstream consequences.”

The findings of our research point to the need to change the narrative around AF to focus more on prevention and aggressive risk factor reduction.

Specifically, the literature suggests many patients at high risk of a stroke fail to receive blood thinning medications, so current preventative efforts are far from ideal.

“Better patient education in areas such as alcohol abstinence and weight loss, as well as appropriate preventative therapy in hospital and primary care, could improve the outcomes for people with AF,” Dr Ngo said.