Professor Graeme Hankey and Steve Quinn Atrial Fibrillation Interview

Professor Graeme Hankey and Steve Quinn Atrial Fibrillation Interview

According to a new report, How Can We Avoid a Stroke Crisis in the Asia-Pacific Region?, urgent coordinated action is needed to avoid millions of preventable strokes, which leave many patients who have atrial fibrillation (AF) both mentally and physically disabled, or dead, every year.

The report, launched during the 18th Asian Pacific Congress of Cardiology (APCC) by Action for Stroke Prevention, a group of health experts from across the globe, proposes urgent measures to prevent stroke in Asian-Pacific patients with AF, the most common, sustained abnormal heart rhythm and a major cause of stroke.2 The report's recommendations are endorsed by 32 leading Asian-Pacific and other global medical societies and patient organisations, reinforcing and recognising the need for a call to action.

A stroke epidemic across the Asia-Pacific region, and indeed the rest of the world, is imminent if actions are not taken now to slow the rising tide of preventable strokes occurring every year. Professor Graeme Hankey, Neurologist and Head of Stroke Unit at the Royal Perth Hospital, commented, "The incidence of stroke across the Asia-Pacific region is continuing to grow and constitutes both a major public health issue and a significant economic burden. Members of Action for Stroke Prevention have come together to highlight the risk of a stroke crisis and urge policymakers, national governments, healthcare professionals, patient groups and medical societies to act together now to prevent the devastating impact stroke has on people, their families and carers."

Recommendations made by the Report include:
Improving awareness of the impact of AF and AF-related stroke
Developing methods for early and adequate diagnosis of AF and stroke risk assessment
Taking new and better approaches to prevent stroke in patients with AF
Facilitating the exchange of best practice between national governments in the Asia-Pacific region
Developing strategies to support adherence to guidelines
Providing equal and adequate administration of therapy for patients with AF across countries in the Asia-Pacific region
Advancing research into the causes, prevention and management of AF; and addressing the current paucity of epidemiological information vailable in Asia-Pacific.

Strokes are preventable - prevent them :
"With the majority of AF-related strokes being preventable, we believe that implementation of these recommendations now will contribute to the prevention of stroke in patients with AF and, in turn, reduce the dramatically increasing clinical, economic, and social burden of stroke in Asia-Pacific," said Professor Gregory Lip, Professor of Cardiovascular Medicine, University of Birmingham Centre for Cardiovascular Sciences, City Hospital Birmingham, UK.

Every year, 15 million people worldwide experience a stroke. Approximately five million of these suffer permanent disabilities and over five million more die, accounting for 10% of all deaths worldwide.

In the Asia-Pacific region in 2004, the approximate number of patients who had survived a stroke at some point in their lifetime was 4.4 million in Southeast Asia and 9.1 million in the Western Pacific region. In the same year, the number of first-ever strokes was 5.1 million across these regions. This was higher than the estimated number of new cases of cancer.

People who suffer a stroke caused by AF are more likely to remain in hospital for longer, are less likely to be discharged home, and are 50% more likely to remain disabled than patients who have a stroke unrelated to AF. An increasing number of people in the Asia-Pacific region are living with AF. In China alone, up to eight million people suffer from AF.

"Every year thousands of Australians with atrial fibrillation who suffer a stroke are left disabled, regardless of their age" said Ms Wendy Fromhold, Acting Chief Executive Officer of Australia's National Stroke Foundation. "If we do not suffer with atrial fibrillation ourselves, we will almost certainly care for or know someone who does. It is imperative that we all act together to improve the diagnosis and management of AF if we are to prevent the enormous life-changing consequences that stroke has for patients and carers."

The current economic burden of strokes on national economies in Asia-Pacific is significant. For example, China will lose $558 billion in national income due to the combined consequences of heart disease, stroke, and diabetes.

More significantly the impact of stroke is predicted to rise dramatically as the number of individuals affected by AF is expected to increase due to an ageing population and improved survival of patients with conditions which predispose AF (e.g., heart attack).

Interview with Professor Graeme Hankey

Professor Graeme Hankey, Consultant Neurologist and Head of the Stroke Unit at Royal Perth Hospital, Western Australia.

Question: What is Atrial Fibrillation (AF)?

Professor Graeme Hankey: Simply Atrial Fibrillation is an irregularly irregular heart rhythm. Normally a heart beats regularly and what happens with Atrial Fibrillation is that the heart beat is not regular anymore; it is all over the place and becomes a chaotic heart rhythm.


Question: Why is it important to be aware of Atrial Fibrillation (AF)?

Professor Graeme Hankey: Atrial Fibrillation is a common cause of stroke and heart failure - both which are bad health outcomes as a result of Atrial Fibrillation. Generally Atrial Fibrillation is doesn't cause any problems because usually the ventricle is still contracting and that continues to pump the blood out. The atrium one of the chambers in the heart beats, regularly, at 60-100 beats per minute the atrium contracts the chamber in the heart and it empties the blood properties into the ventricle and then the ventricle pumps it out through the body. If the contraction isn't regular and strong then the atrium does not empty properly and the blood stagnates and pulls in the atrium chamber. When the blood stagnates in the chamber it clots and breaks off and can go to the brain and block arteries to the brain which is when a stroke is caused.

Atrial Fibrillation does not very often upset many people, often it is a silent killer because people may be Fibrillating and then a clot forms and they have a massive stroke.


Question: What causes Atrial Fibrillation (AF)?

Professor Graeme Hankey: Atrial Fibrillation is most commonly caused by high blood pressure and the second most common cause is blocked arteries of the heart, coronary heart disease, which means there is not enough blood flow to supply the atrium muscle. The third most common cause is obesity and alcohol as alcohol can damage the heart muscle.


Question: What do we need to do to avoid Atrial Fibrillation (AF)?

Professor Graeme Hankey: To avoid Atrial Fibrillation you need to reduce ones risk of having high blood pressure or blocked arteries to the heart, obesity and drinking too much alcohol. We can lower our blood pressure by not adding salt to foods, maintaining an ideal body weight and exercising regularly. We can also avoid getting coronary heart disease or blocked arteries to the heart by also controlling our blood pressure. We can ensure we have a low blood pressure by not eating saturated fats, eating a balanced diet and not blocking our arteries with cholesterol by eating saturated and trans fats. Obesity can be avoided by watching our diet and alcohol consumption as well as exercising. These are the main things one can do to avoid getting Atrial Fibrillation.

The other thing to do is recognise when you have Atrial Fibrillation. Many people won't know they have Atrial Fibrillation, some might because they feel their heart flutter or palpitate. Normally you can feel your heart beat and it is regular, if you feel it is irregular and it is all over the place or have any concerns you can visit your doctor, who will feel your pulse, if your pulse is irregular they will do an ECG (electrocardiogram) to see if Atrial Fibrillation is the cause of the irregular pulse.


Question: If you are diagnosed with Atrial Fibrillation (AF) is it treatable?

Professor Graeme Hankey: Yes. If you're diagnosed with Atrial Fibrillation the first thing to ask is what's the cause? And, can this cause be treated to prevent Atrial Fibrillation being sustained? Therefore, have you got high blood pressure that can be treated with diet, exercise or drugs? Or, have you got coronary heart disease that can be treated by lowing cholesterol or blood pressure? Or, do you need any revisualisation, a plumbing job of the heart to open the arteries? Another question would be, are you overweight and should we lower that? As well as what is your alcohol intake?

Once you can watch the cause you have to decipher if you have any symptoms - do you have palpitations and are they upsetting you? You can also feel faint or light headed. Most people do not have any symptoms. If the Atrial Fibrillation is upsetting the patient, drugs can be provided to slow the rate of the heart and to improve the symptoms. The most important thing is to reduce the risk of clots forming in the heart when it is fibrillating, to prevent strokes with blood thinning drugs.

There has been a lot of new interest with the blood thinning drugs because traditionally doctors have relied on Warfarin to thin the blood and reduce the risk of strokes by about 2/3 of people with Atrial Fibrillation. Warfarin is difficult to monitor and is often associated with an increase in bleeding because it paralyses some of the clotting protein. Warfarin patients also have to monitor their INR (Internationalised National Ratio) and a normal persons clotting ratio is 1:1 but with Wardrain the INR needs to be 2 and 3 which means the blood is 2 to 3 times thinner than normal. When the INR is between 2 and 3 it is very effective but if less than 2 the patient is prone to clotting and more than 3 means the blood is too thin and prone to bleeding. People have difficulty with the INR because Warfarin interacts with so many foods, drugs and drinks which means the control is very irregular which means they need to have their blood checked, often. Broccoli, green leafy vegetables and alcohol all affect Warfarin, which means the control can go out.

There has been a lot of research to find a new drug that does not require monitoring and interact with other drugs. A new drug called Dabigatran has been studied and found to be just as effective, if not more effective as Warfarin and just as safe. Dabigatran has just been approved by ETA in Australia and it will be launched in May, 2011. The new alternative is taken twice a day and you do not need regular blood tests and it has a predictable response without interacting with foods and drugs.

The important thing about Atrial Fibrillation is that it is a potential silent killer but if it is recognised there is an effective treatment to recognise the risk of death or stroke. There is also a more effective and safe treatment on the horizon.

Interview with Steve Quinn

Question: Can you talk about how you were diagnosed with Atrial Fibrillation (AF)?

Steve Quinn: Atrial Fibrillation is a progressive disorder and it comes and goes, you may have a run of irregular heartbeats, but by the time you get to the doctor or a hospital they have disappeared. It is hard to get a concrete diagnose of Atrial Fibrillation straight up. I was in a situation were I would tell a doctor my symptoms and they thought I had Atrial Fibrillation but it is not until you can coordinate to be in their offices doing a stress test with an ECG (electrocardiogram) or you can get to an hospital when you are still experiencing and Arrhythmia that they can diagnose Atrial Fibrillation.


Question: When you were finally diagnosed how did you go about telling your family and friends?

Steve Quinn: It is hard to explain Atrial Fibrillation because you know that there is something wrong with you but you go through a process that every time you go to the doctor they say 'the tests are clear' so you start to believe that you may be going off your head and there is nothing wrong with you.


Question: What treatment are you using for Atrial Fibrillation (AF)?

Steve Quinn: There are a couple of options with your cardiologist. One is medication which controls the rate of your heart beat and the other one is an operation of Cardiac ablation where they go inside the heart and burn the tissue to stop the abnormal electrical currants. I have had both treatments.


Question: How does Atrial Fibrillation (AF) affect your life, daily?

Steve Quinn: I get the occasional Arrhythmia now but I am a good 95% better than I was before. Atrial Fibrillation affects my life when it does occur, I am quite lucky that the operations have worked to a large extent, with me. One of the key messages is the operations are not a silver bullet, they do not work 100% of the time for 100% of the people and in fact for Atrial Fibrillation it is about 80-85% of the time which leaves a large proportion of the population still living with Atrial Fibrillation. There is a constant fear of stroke so every time you go into Atrial Fibrillation you think, is this the time? There is always that worry in the back of you mind and you have to tell your family and friends because everybody needs to know about it, incase something happens to you. Atrial Fibrillation limits were you can go; you almost go back to being like a teenager where you have to tell people 'I'm going here and I'm going to be this long and I have my phone with me, please don't worry about me'.

I have to watch what I eat, exercise and not drink too much alcohol, as well. I have to look after myself and always exercise, with people and make sure there is somebody there with me.


Question: Could you talk about your fundraising efforts for Atrial Fibrillation (AF)?

Steve Quinn: When I was going through the Atrial Fibrillation process I sat down with my wife and said 'Look this is terrible, nobody knows about Atrial Fibrillation and it should be known about in the public arena because it causes more strokes than any other condition'. People don't know about it so I wanted to do something about that and create awareness for Atrial Fibrillation. The first ride I did was in 2008 and it was across America and we raised money for The Victor Chang Cardiac Research Institute (VCCRI). In 2009 I took some mates up to Sydney and we rode up there and raised money for Baker IDI Heart and Diabetes Institute in Melbourne and for The Victor Chang Cardiac Research Institute (VCCRI), again. The Baker Baker IDI Heart and Diabetes Institute and The Victor Chang Cardiac Research Institute (VCCRI) are the two recipients of our funds. Last year we rode from Adelaide back to Melbourne with 20 people and raised just over $90,000. This year we are hoping to bring 40 people from Canberra through the High Country back down to Melbourne.


Question: How can our readers get involved?

Steve Quinn: They can have a look at our website which is www.paceline.com.au. All the information is on the website and we update the page regularly.

Atrial Fibrillation affects a lot of people and their carers. My wife now has to watch me and other people may be in their 30's or 40's who are now looking after an older parent. Atrial Fibrillation affects a big group around the person and there is a massive aging population and it will become a drain on the health system and tax payer's money so anything we can do as a preventative measure is fantastic. It's important to have community awareness; people need to get to their doctor early because the prognosis is better the earlier you get it.

I am a bit vague on this statistic but I think it is about 30% of people with Atrial Fibrillation, the first symptom they have is when they have a stroke. The symptoms of Atrial Fibrillation can be very mild and sometimes they can be very heavy - it can go from a little vibration in your heart to quite a pounding. I actually thought it was a normal feeling, so if people are not aware of it and don't go and see a doctor, heaven forbid their first symptom is a stroke.


Interview by Brooke Hunter