Atrial fibrillation, stress and yoga

Atrial fibrillation is a cardiac rhythm disorder marked by the rapid and irregular beating of the atrium. Currently, there is no known cure for this condition, while management focuses on relief and prevention. Yet a study from 2016 has uncovered a new method of dealing with the symptoms of this condition: yoga.

As reported by Escardio.org, yoga has been shown to improve the quality of life of patients afflicted with paroxysmal atrial fibrillation. “We found that patients who did yoga had a better quality of life, lower heart rate and lower blood pressure than patients who did not do yoga,” said Maria Wahlström, a co-author of the study.

To come to this conclusion, Wahlström and her colleagues recruited 80 patients, all of whom had been diagnosed with paroxysmal atrial fibrillation. Each of the patients’ heart rates and blood pressure were measured at the beginning of the study, and again at the end. The team also evaluated the patients’ quality of life — which encompassed physical and mental health — using validated questionnaires.

The patients were then randomly placed into two groups. The first group or control group received the standard treatment for paroxysmal atrial fibrillation, which consisted of medication, cardioversion, and catheter ablation whenever necessary. The second group underwent standard treatment as well, but supplemented it with yoga. Once a week for 12 weeks, the patients in the yoga group performed yoga sessions that included deep breathing, light movements, and meditation.

At the end of the study, the researchers found that yoga group scored better than the control group. Specifically, the yoga group had higher mental health scores, lower heart rates, and lower blood pressure scores (both systolic and diastolic) compared to the others.

“It could be that the deep breathing balances the parasympathetic and sympathetic nervous system, leading to less variation in heart rate. The breathing and movement may have beneficial effects on blood pressure,” said Wahlström.

She added: “Yoga may improve quality of life in patients with paroxysmal [atrial fibrillation] because it gives them a method to gain some self control over their symptoms instead of feeling helpless. Patients in the yoga group said it felt good to let go of their thoughts and just be inside themselves for awhile.

“A lot of the patients I meet who have paroxysmal [atrial fibrillation] are very stressed. Yoga should be offered as a complementary therapy to help them relax. It may also reduce their visits to the hospital by lowering their anxiety until an [atrial fibrillation] episode stops.”

Following the results, Wahlström and her colleagues began a new study that focused on 140 patients with symptomatic paroxysmal atrial fibrillation. Instead of being divided into two groups, the researchers randomized the patients into three: a control group, a yoga group, and a music relaxation group. The aim of this study is to determine whether the health benefits of yoga lay in the relaxation or the movement and deep breathing.

Fast facts on atrial fibrillation

• There are three types of atrial fibrillation: paroxysmal, persistent, and chronic. According to Healthline.com, paroxysmal atrial fibrillation is characterized by the occasional occurrence and spontaneous cessation of atrial fibrillation. Persistent atrial fibrillation can go on for seven days and needs medication or electric shock treatment to stop. Chronic fibrillation lasts for several years, and those with this condition can’t return their heart rhythm to normal.
• Atrial fibrillation is the most common abnormal heart rhythm disorder, and occurs in as many as 6.1 million people in the United States alone.
• There are numerous potential causes for atrial fibrillation. These include: heart damage caused by heart disease or high blood pressure, medication, binge drinking, inflammation, hyperthyroidism, low potassium and/or magnesium levels, and viral infections, among others. Those with a family history of atrial fibrillation are at risk of this disease too.

Discover what else is and isn’t good for the heart by visiting Heart.news today.

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Afib - silent.........................

When it comes to preventing stroke and heart-related disorders such as heart failure, it’s crucial to identify and properly treat “Afib”—short for atrial fibrillation, the most common type of abnormal heart rhythm. Unfortunately, a significant number of the estimated 3 million Americans who have Afib don’t even realize it.

Now: With new diagnostic and treatment approaches, one’s chances are greater than ever that this potentially dangerous condition can be spotted and stopped—if you receive the right tests and medical care. What you need to know…

WHEN AFIB IS SILENT

If you have Afib, it’s possible to experience a range of symptoms including a quivering or fluttering heartbeat…a racing and/or irregular heartbeat…dizziness…extreme fatigue…shortness of breath…and/or chest pain or pressure.

But Afib can also be “silent”—that is, symptoms are so subtle that they go unnoticed by the patient. Silent Afib is sometimes an incidental finding during a physical exam when the doctor detects an irregular heartbeat. It may also be suspected in patients with nonspecific symptoms such as fatigue or shortness of breath—especially in those with a family history of Afib or a condition such as high blood pressure or diabetes that increases risk for Afib. But whether the symptoms are noticeable or not to the patient, the risk for stroke and potentially heart failure remains just as high, so Afib needs to be diagnosed. 

To check for Afib: The standard practice has been to perform an electrocardiogram (ECG) for a few minutes in the doctor’s office to record the electrical activity driving the heart’s contractions. But if Afib episodes are intermittent, the ECG may be normal.

When Afib is suspected based on symptoms such as dizziness and/or palpitations or racing heartbeat, but the ECG is normal, doctors have traditionally recommended monitoring for 24 to 48 hours. This involves wearing a small device that is clipped to a belt, kept in a pocket or hung around your neck and connected to electrodes attached to your chest. But this approach, too, can miss occasional Afib episodes.

What works better: Longer-term monitoring. Research published in The New England Journal of Medicine found that Afib was detected in five times more patients when they were monitored for 30 days instead of only 24 hours. Guidelines from the American Heart Association now recommend Afib monitoring for 30 days within six months after a person has suffered a stroke with no known cause.  

New option: With a doctor’s supervision, mobile ECG devices (about the size of a cell phone) can now be used periodically to record 30-second intervals of your heart rhythm. Ask your doctor for details.

GETTING THE RIGHT TREATMENT

Afib almost always requires treatment. Besides the danger of stroke, the condition tends to worsen if left alone—symptoms become more troublesome, and normal rhythm is harder to restore.

There are numerous options depending on other risk factors, your treatment goals and your own preference. Treatment is chosen based on frequency and severity of symptoms and whether the patient already has heart disease. Examples…

Prevent stroke. To keep clots from forming, many patients need blood-thinning medications (anticoagulants). The old standby, warfarin (Coumadin), is effective but requires regular blood tests and dietary restrictions.

In recent years, a new generation of easier-to-use anticoagulants has appeared, including dabigatran (Pradaxa), rivaroxaban (Xarelto) and apixaban (Eliquis). These newer drugs have no dietary restrictions and do not require routine blood tests. However, all anticoagulants carry the risk for bleeding, which is harder to stop with the newer drugs.    

Some patients at otherwise low risk for stroke may need only low-dose aspirin (such as 81 mg daily).

Slow down a rapid heart rate. This is usually done with a beta-blocker like atenolol (Tenormin) or a calcium channel blocker like amlodipine (Norvasc) or diltiazem (Cardizem).

Normalize heart rhythm. Anti–arrhythmic drugs, such as amiodarone (Cordarone), flecainide(Tambocor) and dofetilide (Tikosyn), are available. However, these are powerful drugs, with potentially serious side effects (such as dizziness and uncontrollable shaking), that can worsen rhythm abnormalities and must be used cautiously.

Ablation. Another option to normalize heart rhythm and reduce stroke risk is known as ablation. With this procedure, the doctor threads a series of catheters up a vein to the heart to destroy the tiny group of cells that generate electrical impulses that cause fibrillation.

The procedure may have to be repeated but may be a good alternative to lifelong drug treatment. Ablation used to be saved for patients who didn’t respond to drugs, but it’s being offered as first-line therapy nowadays for those who want to avoid lifelong medication.

New procedure: Just last year, the FDA approved a procedure that can sharply reduce Afib stroke risk—left atrial appendage occlusion places a plug in a tiny sac of the atrium where 90% of clots form.

Each of these procedures, which eliminates the need for long-term blood thinning, carries a small risk for serious complications, such as stroke, and is best performed in a hospital that has experience with the surgery and the resources and expertise to provide emergency backup if needed.

An anti-Afib lifestyle. The best way to cut your odds of developing Afib is to modify risk factors. If you have high blood pressure or sleep apnea, get effective treatment. If you’re obese, lose weight. Exercise regularly. If you have Afib, these steps will make your treatment work better—and reduce symptoms.

Source: Source: Walid Saliba, MD, medical director of the Center for Atrial Fibrillation and director of the Electrophysiology Lab at Cleveland Clinic. His research has been published in many  journals, including Circulation: Arrhythmia and Electrophysiology and American Journal of Cardiovascular Drugs. Date: October 1, 2016 Publication: Bottom Line Health

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Non-screening of those at high risk

PRINCETON, N.J. & NEW YORK--(BUSINESS WIRE)--New research released today by The Economist Intelligence Unit (EIU), a division of The Economist and a leader in global business intelligence, revealed that on average, more than 75 percent of people aged 65 and older worldwide are not being screened for atrial fibrillation (AF) and other common stroke risk factors during routine primary care examinations, even though this population is at high risk for stroke. The EIU “Preventing Stroke: Uneven Progress” report, sponsored by The Bristol-Myers Squibb-Pfizer Alliance, conducted an analysis of 20 countries and found that efforts to screen people for stroke risk factors including AF and hypertension varied widely, even in countries with established health care and developed economies.

“Stroke is the second leading cause of death globally, accounting for 6.2 million deaths,¹ but is nearly 80 percent preventable,”² said Becca Lipman, editor of the EIU’s thought leadership division and of this report. “Our hope is that this research will elevate the awareness and urgency surrounding screening for stroke risk factors including AF and hypertension and offer suggestions on what can be done on a country-by-country level to further improve prevention. There are critical and urgent opportunities to improve screening, so that fewer people suffer the devastating consequences of stroke.”

The “Preventing Stroke: Uneven Progress” report considered policy efforts to assess and reduce risks of stroke across different aspects including awareness, screening practices and policies. Key findings include:

• There is a disconnect between established best practices and everyday clinical practice. For example, there are gaps in the training of health care professionals to properly identify and treat stroke risks.
• Screening for AF and hypertension remains low and is not regularly performed in clinical practice.
• Future policies should focus on strategies to improve awareness of stroke risk factors, implement systematic and/or opportunistic screenings, and include both individual and population-based health-intervention approaches.

“People with AF are at least three times more likely to have a stroke than those without this condition,”^3,4,5 said Rory O’Connor, MD, Chief Medical Officer, Pfizer Internal Medicine. “Even modest improvements in diagnosis and treatment of stroke risk factors including AF – supported by collaborations across healthcare providers, advocates, policymakers and the private sector – could potentially prevent many strokes and related deaths.”⁶

“We are committed to supporting increased early detection and diagnosis with the goal of ultimately reducing the prevalence of AF-related strokes globally,” said Christoph Koenen, MD, MBA, VP, Development Lead, Cardiovascular Medicine, Bristol-Myers Squibb. “By working to implement research-driven approaches, The Bristol-Myers Squibb and Pfizer Alliance is aiming to close gaps that are currently leaving undiagnosed and under-treated AF patients at unnecessary risk for stroke.”

About The Economist Research Initiative

Bristol-Myers Squibb and Pfizer sponsored the Preventing Stroke: Uneven Progress initiative conducted by The Economist Intelligence Unit (EIU), a world leader in global business intelligence and the business-to-business arm of The Economist Group, which publishes The Economist newspaper. The EIU researched the progress in stroke prevention and policies made by 20 different countries – Australia, Belgium, Brazil, Canada, China, France, Germany, Italy, Japan, Mexico, the Netherlands, Norway, Russia, Saudi Arabia, South Africa, Spain, Sweden, Turkey, the UK and the United States. The EIU developed a scorecard to assess each country’s performance across four different categories and conducted in-depth interviews with experts on cardiovascular health and stroke, which were included in the final report. For more information and/or to access the research, please visit www.eiuperspectives.economist.com/healthcare/policy-approaches-stroke-prevention.

About the Bristol-Myers Squibb and Pfizer Alliance

The Bristol-Myers Squibb and Pfizer Alliance is committed to driving education and awareness about atrial fibrillation and venous thromboembolism. With long-standing cardiovascular leadership, global scale and expertise in this field, the Alliance strives to implement global, research-driven approaches to illuminate and address the unmet needs around strokes related to non-valvular atrial fibrillation, which are often fatal or debilitating.⁷ Through collaborations with non-profit organizations, the Alliance aims to provide patients, physicians, and decision makers with the information they need to understand and take appropriate action on risk factors associated with stroke and other cardiovascular conditions.

About Bristol-Myers Squibb

Bristol-Myers Squibb is a global biopharmaceutical company whose mission is to discover, develop and deliver innovative medicines that help patients prevail over serious diseases. For more information about Bristol-Myers Squibb, visit us at BMS.com or follow us on LinkedIn, Twitter, YouTube and Facebook.

About Pfizer Inc.: Working together for a healthier world ^®

At Pfizer, we apply science and our global resources to bring therapies to people that extend and significantly improve their lives. We strive to set the standard for quality, safety and value in the discovery, development and manufacture of health care products. Our global portfolio includes medicines and vaccines as well as many of the world's best-known consumer health care products. Every day, Pfizer colleagues work across developed and emerging markets to advance wellness, prevention, treatments and cures that challenge the most feared diseases of our time. Consistent with our responsibility as one of the world's premier innovative biopharmaceutical companies, we collaborate with health care providers, governments and local communities to support and expand access to reliable, affordable health care around the world. For more than 150 years, we have worked to make a difference for all who rely on us. We routinely post information that may be important to investors on our website at www.pfizer.com. In addition, to learn more, please visit us on www.pfizer.com and follow us on Twitter at @Pfizer and @PfizerNews, LinkedIn, YouTube and like us on Facebook at Facebook.com/Pfizer.

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Check your pulse!

The Daily Mail reports that, if doctors checked the pulse of every patient they see, this measure could “prevent 12,000 strokes a year”.

The aim of the pulse checks would be to pick up cases of atrial fibrillation, a common heart rhythm disorder that increases the risk of a stroke.

The figure comes from a report released by the Atrial Fibrillation Association (AFA) and Anticoagulation Europe (ACE), which warn that there is a “silent epidemic” of atrial fibrillation and that this will worsen in the UK as the population ages. The report also sets out a number of ways that might improve the diagnosis and treatment of atrial fibrillation, including campaigns to raise awareness, further training for GPs and improved access to heart monitoring when a case is suspected.

What is atrial fibrillation?

Atrial fibrillation is a heart rhythm disorder where the upper chambers of the heart (the atria) contract in a faster and shallower way than normal, causing an irregular heartbeat. While this is happening the heart is less effective at pumping blood around the body.

There are three different forms of atrial fibrillation, based on how long the fibrillation lasts:

• paroxysmal atrial fibrillation: a form that comes and goes and usually stops within a couple of days with no treatment
• persistent atrial fibrillation: a longer-lasting form that typically lasts longer than a week, but can resolve more quickly if treated
• permanent atrial fibrillation: a form that is present all the time

The AFA/ACE report estimates that 1.5 million people in the UK have atrial fibrillation but that currently up to half of these cases remain undiagnosed.

What are the signs of atrial fibrillation?

Not all people with the condition will show symptoms of atrial fibrillation. In people who do have symptoms, these can include:

• breathlessness
• palpitations
• fainting or dizziness
• chest discomfort

With atrial fibrillation you may also have an irregular pulse.

How is atrial fibrillation currently diagnosed?

NICE recommends that people going to their doctor with any of the signs described above, or who have had a stroke or mini-stroke, should have their pulse checked manually to see if it’s irregular. People who have no symptoms may also have an irregular pulse detected just by chance, when visiting their doctor for another reason.

NICE suggest that an electrocardiogram (ECG) should be performed in all patients who have an irregular pulse and are suspected to have atrial fibrillation, even without symptoms.

What are the risks associated with atrial fibrillation?

Blood does not flow smoothly out of the heart during an episode of atrial fibrillation, and this increases the risk of blood clots forming. Because of this, people with atrial fibrillation are at an increased risk of having a stroke (where a blood clot lodges in the brain). Atrial fibrillation can also lead to heart failure.

The factors reported to increase the risk of stroke in people with atrial fibrillation include:

• being female
• being elderly
• having previously had a stroke or TIA (mini stroke)
• having high blood pressure
• having heart failure or valvular heart disease
• having diabetes
• having vascular disease

How is atrial fibrillation treated?

There are various ways of treating atrial fibrillation, depending on the form it takes and other factors. Possible treatments include drug treatment, electrical treatments and surgery. People with atrial fibrillation who also have other risk factors for stroke should also take an anticoagulant to reduce their risk.

What does the report say about checking patients’ pulses?

The AFA and ACE recommend the following measures:

• a national screening programme for atrial fibrillation that targets those at risk of atrial fibrillation and stroke
• an audit in general practices to identify and flag up patients at risk of atrial fibrillation
• manual pulse checks on all patients at risk of atrial fibrillation when they visit their GP’s surgery
• immediate access to an electrocardiogram (ECG) for patients in whom atrial fibrillation is suspected
• readily available 24- and 48-hour heart monitoring, to diagnose intermittent atrial fibrillation

What is the current policy on atrial fibrillation screening?

Screening is a process of identifying apparently healthy people who may be at an increased risk of a disease or condition. The screening process does not include testing people who already have symptoms.

The UK National Screening Committee (NSC) advises government ministers and the NHS on all aspects of screening and supports implementation of screening programmes. National screening programmes for healthy people can be expensive and potentially lead to an increase in investigations and treatments for people who might not necessarily have developed symptoms or problems. The committee regularly assesses the evidence about new screening programmes that could be offered, to determine whether they would do more good than harm at a reasonable cost.

Currently, the NSC’s recommendation is that routine screening for atrial fibrillation in adults should not be offered. This policy is being reviewed. This review involves identifying any relevant new evidence published since the policy was made and assessing whether this evidence suggests that the policy should be changed. The review began in January 2010 and is expected to be completed by March 2012.

What else does the report call for?

The AFA and the ACE’s extensive report also calls for:

• ways to increase GP motivation to follow international guidelines on how atrial fibrillation should be managed
• a national public and patient education campaign to improve detection of atrial fibrillation and promote patient empowerment, using existing materials
• equal access to atrial fibrillation treatments and services for all NHS patients, regardless of location
• an atrial fibrillation education campaign for GPs
• government support for research into the causes, prevention, and treatment of atrial fibrillation
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Atrial fibrillation

Dr Mike Knapton, Associate Medical Director at the British Heart Foundation, said: “Thousands of people with atrial fibrillation are needlessly dying of stroke every year because they are not being identified, and adequately managed.

“There are still hundreds of thousands of people undiagnosed with AF, putting them at significant increased risk of suffering a stroke.

“Research is helping us understand the links between AF and stroke, but there is still much more to do.

“We need to detect people with an irregular heartbeat and then ensure they are getting the right care and treatment to reduce their risk of having a stroke.”

Strokes can be fatal, but those who do survive can be left with brain damage.

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