With the increasing prevalence and burden of atrial fibrillation (AFib), this series of three online programs focuses on the importance of anticoagulation in reducing the incidence of AFib-related stroke, current methods to optimize warfarin therapy, and the potential impact of emerging treatment options.
Cardiologists, Internists, Primary Care Physicians, Nurse Practitioners, Physician Assistants and related healthcare providers.
Statement of Need:
Atrial fibrillation (AFib) affects approximately 2.2 million Americans and is likely to increase in prevalence due to the aging of the US population (AHA, 2010). During AFib, blood is ineffectively pumped out of the atria, often resulting in clotting. Stroke may occur if a clot then leaves the heart and is lodged in a cerebral artery. Individuals with AFib are at five times greater risk of stroke and approximately 15 percent of stroke incidences occur in AFib patients (Savelieva I et al., 2007). Moreover, AFib-related stroke is typically associated with greater morbidity and mortality (Savelieva I et al., 2007). Warfarin and aspirin are currently FDA approved to reduce the risk of stroke in AFib, and guidelines recommend people with AFib who are at moderate-to-high risk of stroke to be initiated on chronic warfarin therapy (Turpie AG, 2008)(Fuster V et al., 2006). However, despite guideline recommendations and studies demonstrating the benefits of anticoagulation in patients with AFib, 50 percent of ideal candidates go untreated due in part to warfarin complications (Savelieva I et al., 2007) (Fuster V et al., 2006)( Hart RG et al., 2007). Non-pharmacological interventions, such as catheter ablation, have also demonstrated the ability to restore sinus rhythm and reduce stroke risk in patients with AFib (Lévy S, 2006) (Crijns HJ, 2005). These treatment options are also of importance for clinical decision makers and present challenges due to the associated complexities of these procedures, including the need for sophisticated electrophysiology laboratories, expensive imaging techniques, and well-trained staff. Despite these interventions, data have indicated the need for long-term anticoagulation. (Echahidi N et al., 2008).