Atrial Fibrillation (AFib) | Q&A
Atrial Fibrillation Patients and Doctors Have a Communication Gap
One-third of patients don't know the stroke symptoms to look for, and surveyed doctors say their atrial fibrillation patients don't understand stroke risk.
By Kathleen Doheny
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Patients with atrial fibrillation (afib) and the doctors who treat them have a serious communication gap, according to a new survey.
The , presented at the November 2014 American Heart Association annual meeting in Chicago, suggest that improved education for both patients and doctors is needed — if the stroke risk linked with afib is going to be managed effectively.
Afib, the most common heart rhythm problem in adults, affects more than 2.7 million in the United States. And the condition increases stroke risk more than fivefold.
But the new survey uncovered knowledge gaps and lack of communication about this stroke risk, says David Frankel, MD, assistant professor of medicine at the Perelman School of Medicine, University of Pennsylvania. He is chair of the Heart Rhythm Society’s atrial fibrillation-impact of stroke survey working group.
He oversaw the survey, which polled 1,200 doctors, patients, and their caregivers about afib and stroke. The survey included 500 patients (half had stroke, half not), 500 doctors (cardiologists, neurologists, electrophysiologists and primary care doctors), and 200 caregivers of afib patients who had a stroke.
The questions zeroed in on treatment, understanding of the afib condition and stroke, and how the condition affected caregivers.
The survey was a collaborative effort between the Heart Rhythm Society and The National Stroke Association. Also, Boehringer Ingelheim, maker of an anticoagulant medication for afib, funded the survey but had no role in it.
Survey Key Findings on Afib and Stroke
- 90 percent of doctors said their patients underestimate the impact a stroke caused by afib would have on their lives.
- 79 percent of doctors said afib patients are “in denial” about ischemic stroke risk.
- However, 66 percent of patients said they were not aware that afib-related strokes are nearly two times as likely to be fatal as other strokes.
- And 32 percent of the afib patients, who had not had a stroke yet, couldn’t identify common stroke symptoms.
- 33 percent of cardiologists and 48 percent of electrophysiologists identified patient resistance as one of the top barriers to starting treatment for afib to reduce risk.
- Yet 93 percent of patients said they would do whatever their doctor told them to reduce stroke risk.
- Among caregivers, 86 percent said they had no idea how much work it would be to care for a stroke survivor.
- For example, 75 percent of caregivers said the stroke patient not only had to give up driving, but also needed help with everyday activities.
Solving the Atrial Fibrillation Disconnect
"I think physicians are overestimating patient resistance," Frankel says. If a doctor can explain how serious stroke is, he says, Frankel believes patients would comply with recommended treatment.
The survey results point to a need for doctors to take more initiative, says T. Jared Bunch, MD, Everyday Health columnist and cardiologist at Intermountain Heart Institute, Medical Director for Cardiac Electrophysiology at Intermountain Health Care in the Salt Lake City area. Dr. Bunch reviewed the study findings.
Right at the point of diagnosis of afib, he says, doctor and patient must discuss the condition, the associated risks, and how to prevent stroke. That is the ''cornerstone" of afib management, Bunch says.
"The results of the survey should be a wake-up call to physicians to improve their communication of the significant risks associated with atrial fibrillation," he says.
Although the survey findings suggest both patients and doctors could do better, he says doctors need to take the lead. Besides a thorough discussion of the condition and risks, Bunch says he often points patients to recognized internet sites for patient information on stroke that can help them learn at their own pace at home. Resources to tap into include the National Stroke Association and the .
RELATED: Half of U.S. Women Don’t Know Signs of Stroke: Do You?
As for the patient resistance to treatment cited in the survey, Bunch finds that it's often due to a lack of understanding of the afib condition and stroke risks.
Take-Home Tips for Patients and Families
The best measures patients and families or caretakers can use, Frankel says, are these:
- Learn about your risk of stroke with afib right away.
- Ask your doctor how you can reduce that risk.
- Learn to recognize the common symptoms of stroke: one side of the face may droop, one arm may drift downward, and speech may become slurred or strange. If you see any of the signs, it is time to call 9-1-1 right away, according to the National Stroke Association.
- Understand the negative impact stroke has on quality of life of both patients and loved ones who are in a caregiving role.
- Be ready to communicate with your doctor and to follow treatment instructions to lower stroke risks as much as possible.
Video: A patient's experience with atrial fibrillation (afib)
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