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Heart Health, Explained

Arrhythmia: Growing Rate of Atrial Fibrillation

The number of hospital stays for the most common form of irregular heartbeat, atrial fibrillation or AF, nearly doubled in the 12 years between 1998 and 2010, and is expected to continue increasing throughout this decade, according to findings presented at the American Heart Association’s annual meeting and reported November 18, 2013 by HealthDay News and WebMD.

Growing Rate of Atrial Fibrillation Q&A

Q: What accounts for this tremendous increase in hospitalization for atrial fibrillation?

A: Atrial fibrillation or AF is the most common arrhythmia, a medical term for abnormal heart beat. AF is more common in people 65 and older, and the increase in hospitalization for AF may relate to an aging population. With aging, AF increases in frequency and typically occurs in people who have underlying heart disease. Almost any heart disease can increase the risk of this abnormal rhythm. But the most common causes are conditions such as high blood pressure (hypertension), heart valve disease, prior heart attack, and heart failure. High blood pressure is called “the silent killer” because individuals with this condition often feel no symptoms. However, high blood pressure increases risk of stroke, heart attack, and arrhythmia. Longstanding untreated high blood pressure, which is more commonly noted in women than men, is frequently a cause of atrial fibrillation. As obesity is also a cause of atrial fibrillation, the current obesity epidemic may be playing a role in the increase in hospital stays for AF. Other conditions and lifestyles related to increased risk of AF include obstructive sleep apnea, thyroid disorders, diabetes mellitus, reactions to and side effects of medications, excessive caffeine consumption, and smoking. Many of these factors are inter-related, and contribute to the overall increase in diagnoses and hospitalization for atrial fibrillation.

Reference: American College of Cardiology – Atrial Fibrilation web page

Q: What are the main risk factors for AF, and do women and men experience this condition differently?

A: The most common risk factors for AF include advancing age, heart disease, high blood pressure/hypertension, obesity, obstructive sleep apnea, over- or under-active thyroid disease, and heart valve disease. Lifestyle factors such as excessive alcohol consumption, sleep deprivation, smoking, and excessive caffeine consumption can also increase AF risk. Atrial fibrillation can also occur in individuals without risk factors. Certain athletes, such as long distance cyclists, rowers, and runners, have been reported to experience AF. Most people who develop AF are older than 65 years of age. Although atrial fibrillation is more common in men than women, women tend to have more difficulty with AF symptoms and often report a poorer quality of life than men after diagnosis. These symptoms include heart palpitations, lightheadedness and dizziness, being short of breath, fatigue, and chest tightness and discomfort. Some patients do not have any arrhythmia symptoms. While experts are not sure why women experience more AF symptoms, they speculate that it may be because women have faster heart rates and smaller bodies than men.

Q: AF is more common in men than women, but women with AF have a greater risk of stroke. How can a woman with AF lessen stroke risk?

A: Many patients are not limited by symptoms with AF. However, AF plays a significant role in risk of stroke whether or not a person feels symptoms. Doctors consider multiple factors when estimating someone's risk of stroke when diagnosed with AF, including heart failure, age 75 years or greater, diabetes, hypertension, and prior stroke or transient stroke. Studies also show that, compared to men, women have a greater risk of stroke when diagnosed with atrial fibrillation. A stroke resulting from AF is caused by a blood clot that blocks blood flow to the brain. In people with AF, the risk of stroke begins when the electrical signals that control the heartbeat become abnormal. As a result, the top two chambers of the heart stop pumping effectively, and blood that should move out of these chambers pools and can form clots. If dislodged, these clots can travel up to the brain through the blood vessels, causing strokes. In many cases, taking a medicine to thin the blood to prevent the formation of blood clots is a key part of reducing risk of stroke for women who have AF. There are multiple medications available that function as blood thinners to reduce women's stroke risk. Keeping blood pressure and diabetes well controlled also helps lessen a woman's AF -related stroke risk.

HEALTH NEWS IN PERSPECTIVE

Answers to your questions on timely topics in cardiac care to help make sense of research reports in the media. The series includes questions on your heart and the effect of medications, exercise, diet, and hormones.

Team Specialist

Anne Albers, MD, PhD, RVT
 Fellow of the American College of Cardiology American Society of Echocardiography, American Heart Association Cardiologist, OhioHealth Heart & Vascular Physicians OhioHealth Healthcare System, Columbus, Ohio

Q&A Editor

Teresa Caulin-Glaser, MD, FACC, FAACVPR System Vice President, Heart & Vascular Services OhioHealth Healthcare System, Columbus, Ohio

Heart Health Explained is a collaboration of Women’s Health Research at Yale and the OhioHealth Healthcare System, a nationally recognized not-for-profit organization with providers across 46 counties, offering a holistic approach to prevention, treatment and rehabilitation of heart disease. OhioHealth is staffed by physicians, psychologists, nutritionists and nurses who answer the questions of the moment on heart and vascular health.

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