Stroke hits bumpy hearts

BAKER IDI

Around one in five older Australians with atrial fibrillation are undiagnosed and live at heightened risk of stroke. Image:onurdongel/iStockphoto More than 3,500 debilitating, often fatal and entirely ‘unnecessary’ strokes will be suffered by Australians with an irregular heartbeat this year, according to a new report by medical experts and health economists. These experts warn that thousands of Australians will be incapacitated and up to 700 lives lost to ‘preventable’ strokes in 2011 because of a widespread failure to provide effective stroke prevention for many Australians diagnosed with this increasingly common heart condition. In addition, the report notes that around one-in-five older Australians with atrial fibrillation are undiagnosed and live at heightened risk of stroke. Commissioned by Boehringer Ingelheim and developed in conjunction with experts from the Baker IDI Heart & Diabetes Institute, Florey Neuroscience Institutes, the report reveals: Almost 25 per cent of first-ever strokes (10,709 of 45,873) in 2011 will be specifically caused by atrial fibrillation at a cost to the economy of $314 million this year alone; Nearly 7,500 strokes will occur in people with either undiagnosed or diagnosed but untreated atrial fibrillation; and At least half (3,532 strokes) could be avoided with the use of effective stroke prevention medicines. The findings of the Deloitte Access Economics Report titled Off beat: Atrial fibrillation and the cost of preventable stroke have prompted medical researchers to call for heightened awareness about who is at risk of atrial fibrillation and an increased use of effective stroke prevention therapy amongst this group. “Atrial fibrillation increases the likelihood of a stroke five-fold yet around 160,000 people at moderate-to-high risk do not receive stroke prevention therapy,” said Professor Garry Jennings, Director, Baker IDI Heart & Diabetes Research Institute. “With more effective stroke prevention medicines and improved diagnosis, there is evidence that we could prevent and drastically reduce the number of strokes in Australia,” he said. “Projections suggest that the burden of atrial fibrillation will continue to grow as the population ages. By taking steps to address this now, we may prevent the number of strokes caused by this condition and maintain quality of life for people who are at high risk.” Deloitte Access Economics estimates the total number of Australians with atrial fibrillation at more than 500,000. This irregular heartbeat can cause blood clots to form in the heart chamber which can travel to the brain and cause a potentially fatal stroke. “Atrial fibrillation related strokes are usually more severe than strokes caused by other factors,” said stroke expert Professor Donnan, Director of the Florey Neuroscience Institutes. “Survivors tend to be more incapacitated and require long-term care in a nursing home; they also have a greater risk of secondary stroke and of dying,” Professor Donnan said. The Deloitte Access Economics Report suggests that the limitations of the most common stroke prevention therapies on the PBS, warfarin and aspirin, is in part responsible for the high rate of preventable strokes amongst atrial fibrillation sufferers. While warfarin is an effective blood-thinner, it is currently prescribed to less than 40 per cent of atrial fibrillation patients who should receive the medication largely because of the risk of internal bleeding and adverse interactions with some foods and common medicines. As a result of these and other factors, warfarin patients require frequent blood monitoring. “The proportion of people currently receiving stroke prevention therapy is totally inadequate. There’s often unwillingness by patients and doctors to initiate a lifetime of warfarin therapy while aspirin alone just doesn’t provide enough protection,” said Professor Donnan. “We also find that the optimum level of blood thinning is only achieved half of the time among warfarin patients. The need for ongoing blood monitoring is also problematic – especially in rural and regional areas where people have to travel significant distances every few weeks.” The cost to society of warfarin-related bleeds and blood monitoring in atrial fibrillation sufferers is estimated by Deloitte Access Economics to be $95.7 million per year. The Report puts the cost of treating each atrial fibrillation-related stroke at around $30,000 in the first year alone. “Preventable strokes are placing a significant burden on our healthcare system and our community,” said Professor Richard Lindley, President, Stroke Society of Australasia. “More effective prevention would reduce the human misery caused by these severe strokes and would also reduce hospital costs.” The Report concludes with a series of recommendations including: initiatives to increase the use of stroke prevention therapy among untreated patients as well as the use of the most effective available treatments; an atrial fibrillation awareness campaign amongst older Australians; and encouraging GPs to routinely check patients over 50 years of age for an irregular heartbeat. Professors Jennings, Donnan and Lindley said that people over the age of 50 should have regular pulse checks to help identify an irregular heartbeat. They also urge Australians who have been diagnosed with atrial fibrillation to discuss stroke risk and stroke prevention therapy with their doctor.