Note: This research study is important if you have Persistent A-Fib or your Paroxysmal A-Fib has progressed to Persistent A-Fib.
The Cost of Waiting to Ablate
In patients with persistent atrial fibrillation undergoing ablation, the time interval between the first diagnosis of persistent A-Fib and the catheter ablation procedure had a strong association with the ablation outcomes.
Cleveland Clinic researchers found that shorter diagnosis-to-ablation time spans were associated with better outcomes. Longer diagnosis-to-ablation times was associated with a greater degree of atrial remodeling.
According to electrophysiologist Dr. Oussama Wazni, “once the diagnosis of atrial fibrillation is made, it’s important not to spend too much time trying to keep a patient in normal rhythm with medical [drug] therapy” before referring for radio-frequency ablation.” Dr. Wazni is Co-Director of the Center for Atrial Fibrillation at the Cleveland Clinic.
His comments are based on the published analysis of two-year outcomes among 1,241 consecutive patients undergoing first-time ablation of persistent atrial fibrillation over an eight-year period at Cleveland Clinic. All patients had successful isolation of all 4 PVs (pulmonary veins), and the superior vena cava was isolated in 69.6%. In addition, Left Atrium ablations (including complex fractionated electrograms) were performed in 65.6% of patients.
First Diagnosis-to-Ablation Time Span: The Shorter the Better
Importantly, the first diagnosis -to-ablation time interval (of persistent A-Fib) had a stronger impact on outcomes than the time spent with a paroxysmal A-Fib diagnosis or the duration of continuous A-Fib before the ablation procedure.
VIDEO: Ablation for Persistent Atrial Fibrillation. In this short video, Dr. Wazni describes the results of research showing that time interval between first diagnosis of persistent atrial fibrillation and catheter ablation had a strong association with ablation outcomes. (Posted by the Cleveland Clinic, Jan 2016; 3:11 min)
Patients with ‘Valvular Atrial Fibrillation’ are often restricted from most A-Fib clinical studies and research. In particular, for NOAC trials, people with Valvular A-Fib have generally been excluded because they may have a higher rate of forming clots (e.g.: left atrial clots).
“Valvular Atrial Fibrillation” refers to those A-Fib patients with artificial heart valves or mitral stenosis.
Like most A-Fib patients, Valvular A-Fib patients with bioprosthetic or mechanical valves have to be on an anticoagulant which up to now was restricted to warfarin. So, are the new NOACs an option?
Bioprosthetic valves are non-synthetic (usually porcine) devices used to replace a defective heart valve. Compared to mechanical valves, bioprosthetic valves are less likely to cause clots, but are more prone to structural degeneration (35% fail within 15 years).
Warfarin vs Edoxaban (NOAC)
A 2017 study showed that the Novel Oral Anticoagulant (NOAC) edoxaban (brand name: Savaysa) was safer than warfarin in preventing an A-Fib stroke in people with bioprosthetic heart valves.
Edoxaban works by inhibiting factor Xa in the coagulation process. The lower dose (30 mg) was associated with a reduced rate of major bleeding, but not the higher dose (60 mg).
Compared to warfarin, edoxaban was associated with lower annual stroke rates, systemic embolic events, major bleeds, and deaths annually.
“Our analysis suggests that edoxaban appears to be a reasonable alternative to warfarin in patients with Afib and remote bioprosthetic valve implantation,” according to Dr. Robert P. Giugliano of Brigham and Women’s Hospital in Boston, MA.
Edoxaban Works With Bioprosthetic Valves But Not Mechanical Ones
For the first time, research indicates that a NOAC (edoxaban) can be used for Valvular A-Fib to prevent an A-Fib stroke―but only in the case of bioprosthetic (porcine) valves.
The NOAC, Edoxaban (Savaysa), was safer than warfarin for A-Fib patients with bioprosthetic valves.
With regards to mechanical valves, the authors cited a study in which dabigatran (Pradaxa) fared poorly in mechanical valves.
What About Other Factor Xa NOACs?
What about the other ‘factor Xa inhibitors’ such as Xarelto and Eliquis? Can they be used like edoxaban? Currently there is little clinical data on this subject. But since all three are factor Xa inhibitors, most likely they will be proven to be effective in A-Fib patients with bioprosthetic valves.
What Patients Need to Know
Do you have Valvular A-Fib and a bioprosthetic valve? Are you on warfarin? If being on warfarin is difficult for you, you now have a choice of anticoagulant. Ask your doctor about switching to the NOAC, edoxaban.
About Atrial Fibrillation and Atrial Flutter…are they linked? Does one precede the other? Can one procedure fix both? Can a typical catheter ablation fix both Atrial Fibrillation and Atrial Flutter at the same time? Can Maze surgery or Mini-maze surgery fix both?
Surgery vs. Ablation
In general, Atrial Flutter originates in the right atrium and Atrial Fibrillation in the left atrium.
Maze/Mini-maze surgical approaches typically don’t access the right atrium, and therefore can’t fix A-Flutter.
Maze/Mini-maze surgical approaches typically don’t access the right atrium, and therefore can’t fix A-Flutter. If you have both A-Fib and A-Flutter, a Maze procedure needs to be followed by a catheter ablation to fix the Atrial Flutter.
A catheter ablation procedure for A-Flutter is relatively easy and it’s highly successful (95%). It usually involves making a single line in the right atrium which blocks the A-Flutter (Caviotricuspid Isthmus line).
A Catheter Ablation Two-Fer?
If you are having a catheter ablation, many doctors make this Caviotricuspid Isthmus ablation line while doing an A-Fib ablation (in the left atrium)—even if you don’t have A-Flutter at the time.
Catheters enter the heart through the right atrium. At the beginning of a catheter ablation for atrial fibrillation, doctors enter the heart through the right atrium. While there they may elect to make the right atrium ablation line at this point which takes 10-20 minutes.
They then go through the wall separating the right and left atria (transseptal wall) to do the ablation for A-Fib in the left atrium. (Some doctors chose to place the right atrium ablation line at the end of an ablation when they withdraw from the left atrium into the right atrium.)
Some say one should “do no harm” and not make this right atrium ablation line if there is no A-Flutter. Saying it can always be done later in another catheter ablation at little risk to the patient.
Research: Are A-Fib and A-Flutter Linked?
While you can have A-Flutter without A-Fib, more often than not, they are linked. When you have A-Flutter, A-Fib often lurks in the background or develops later.
Patients did much better if they had an ablation for both A-Fib and a A-Flutter at the same time even though they appeared to only have A-Flutter.
Some A-Flutter may originate in the left atrium, or the A-Flutter may mask A-Fib which may appear later after a successful A-Flutter ablation.
As many as half of all patients ablated for A-Flutter may later develop A-Fib.
In a small research study, patients did much better if they had an ablation for both A-Fib and a A-Flutter at the same time even though they appeared to only have A-Flutter.
What Patients Need to Know
But right now we can’t say for sure if one causes the other. We do know that A-Flutter usually comes from the right atrium, while A-Fib usually comes from the left atrium.
“While moderate amounts of alcohol appear protective for the ‘plumbing,’ or blood supply to the heart muscle, the benefits of alcohol do not extend to the electrical parts of the heart, or heartbeat.”
Over time, drinking may actually change the electrical signals, triggering irregular heartbeat (arrhythmias).
Risk per Daily Alcohol Drink
A new study found the risk of atrial fibrillation grew by 8 percent for each daily alcoholic drink. The findings were similar for men and women. The authors looked at previous studies that tracked almost 900,000 people over 12 years.
Fibrosis: The study doesn’t establish a direct cause-and-effect relationship. Nevertheless, “cell damage from habitual drinking may lead to small amounts of fibrous tissue within the heart that causes the irregular, quivering heartbeat”, the study authors said.
Post-catheter ablation: The review found that people who continue to drink are more likely to have ongoing irregular heartbeats even after catheter ablation.
Weekly Alcohol Recommendation
Dr. Pater Kistler recommended that those with irregular heartbeat “should probably drink no more than one alcoholic drink per day with two alcohol-free days a week.”
He added they had no randomized data that tells what a ‘safe’ amount is to consume. The study authors called for more research to determine whether avoiding alcohol completely is required for patients who have irregular heartbeats.
Know Your Triggers
Some Atrial Fibrillation patients have sworn off alcohol altogether. Through trial and error, they’ve found that any amount of alcohol contributes to or triggers their A-Fib episodes.
Dr. Kistler’s research is helpful for the balance of A-Fib patients. It offers some research-based guidelines to minimize the impact of alcohol consumption on their A-Fib.
For additional reading, see my article:“Holiday Heart”: Binging Alcohol, Marijuana & Rich Foods.
Do you take the anticoagulant, Xarelto? Or one of the newer NOACs? Which is safest? Which has the least GI bleeding?
NOACs Research Study Results
A Mayo Clinic study indicated that the risk of gastrointestinal (GI) bleeding is higher for patients taking Xarelto than for other anticoagulants in its class.
The researchers compared the gastrointestinal (GI) safety profile of three rival oral anticoagulants: Xarelto (rivaroxaban), Pradaxa (dabigatran) and Eliquis (apixaban). All of the patients in the study had Atrial Fibrillation.
Bleeding occurrence: GI bleeding occurred more frequently in patients taking Xarelto compared to Pradaxa (approximately 20% increased risk), while Eliquis had the lowest GI bleeding risk.
Age factor: They also found that the risk of GI bleeds increased with age. In particular, patients over the age of 75 were at an increased risk.
Safety: Eliquis had the most favorable GI safety profile, even among very elderly patients, and Xarelto had the least favorable. … Continue reading this report…->
We hear it every day on TV, ads about ‘living with Atrial Fibrillation’. In today’s media, the message is about how to ‘manage’ your A-Fib. You’re advised to ‘just take our anticoagulant’ and you’ll live happily ever after.
But recent research (and common sense) indicates otherwise.
Mega Research Analysis of Your Additional Risks
Researchers at Oxford University, Oxford, UK and Massachusetts Institute of Technology (MIT), Cambridge, MA, USA, conducted a systematic review and analysis of 104 different studies involving nearly 10 million people, of which, over a half-million had A-Fib.
They found that Atrial Fibrillation is associated with not just stroke, but also with:
• Heart Disease
• Heart Failure
• Kidney Disease
• Sudden Death
• Death from All Causes
Heart failure: The strongest association was with heart failure, which was five times more likely in people with A-Fib. Because your heart isn’t pumping properly, it’s not surprising that A-Fib leads to heart disease, heart failure and sudden death.
Kidney disease: A surprising association is that A-Fib is tied to kidney disease and peripheral arterial disease, probably because of poor circulation due to A-Fib.
Death from all Causes: This isn’t such a surprising finding as A-Fib affects the whole body. A-Fib damages your heart, brain and other organs. It reduces the heart’s pumping capacity by about 15%-30% which may cause weakness, fatigue, dizziness, fainting spells, swelling of the legs, and shortness of breath.
Patients with A-Fib, even if they don’t have a stroke or heart failure, are more likely to die from other causes compared with people in normal sinus rhythm (NSR).
Note: this study didn’t examine the known link between dementia and A-Fib. See Leaving Patients in A-Fib Doubles Risk of Dementia—The Case for Catheter Ablation
Don’t be Misled by Pharmaceutical Ads
For patients with A-Fib, it isn’t enough to simply take an anticoagulant!
We need to worry not just about stroke, but also about the risks and potential damage of A-Fib to our overall health.
Contrary to today’s media, your goal shouldn’t be to just ‘manage your A-Fib’. It’s a Pollyanna fantasy to just ‘Take a pill (anticoagulant) and live happily ever after’.
That misconceoption is propagated by drug manufacturers who want you to stay an A-Fib patient and thus a customer for life.
Don’t Just Live with A-Fib
Don’t Settle. Seek your A-Fib cure. Your goal should be to get your heart beating once again in normal sinus rhythm (NSR). We can’t say it enough…
Do not settle for a lifetime on meds. Seek your A-Fib cure.
The more people like their doctors, the healthier they tend to be. This is what researchers at Massachusetts General Hospital found in a review study where they examined 13 research reports on this subject.
Being the “Best in the Field” Isn’t Enough
Even if a doctor(s) is the best in their field and an expert in your condition, that may not help you if you don’t communicate well with them and don’t relate to them. If we don’t like our doctors, we’re less likely to listen to them.
Some doctors (particularly those from overseas) often communicate poorly, or talk in “medicalize” and are nearly incomprehensible. Other doctors come from a medical school with a tradition of aloofness and keeping a distance from patients (with women in particular).
Relationship-Based Strategies Improve Patients’ Health
This mega-study review looked at doctors who were trained in “relationship-based strategies” such as making eye contact, listening well, and helping patients set goals. The results: these strategies significantly improved their patients’ health compared to control groups. Their patients achieved lower blood pressure, increased their weight loss, reduced pain and improved glucose management.
If You Don’t Like Your Doctor, Look For a New One!
It’s intuitive, isn’t it? But now a review of studies backs it up. If you like, trust and respect your doctor(s), you’re more likely to accept and follow their advice. Developing a good relationship helps you feel comfortable asking questions and getting feedback in a give-and-take environment.
If you don’t have this rapport with your current doctor(s), it’s worth looking elsewhere for a new doctor―even if they are “the best” in their field.
In the article, Know When it’s Time to Fire your Doctor, CNN.com Senior Medical Correspondent Elizabeth Cohen discusses five ways to know when it’s time to think about leaving your doctor, and the best way to do it. The highlights are:
1. When your doctor doesn’t like it when you ask questions
2. When your doctor doesn’t listen to you
3. If your doctor can’t explain your illness to you in terms you understand
4. If you feel bad when you leave your doctor’s office
5. If you feel your doctor just doesn’t like you — or if you don’t like him or her
Don’t Be Afraid to Fire Your Doctor
Changing doctors can be scary. According to Robin DiMatteo, a researcher at the University of California at Riverside who’s studied doctor-patient communication. “”I really think it’s a fear of the unknown. But if the doctor isn’t supporting your healing or health, you should go.”
To learn more, read our page: How to find the right doctor for you and your treatment goals.
The Longer You Have A-Fib, the Greater the Risk
A-Fib begets A-Fib. The longer you have A-Fib, the greater the risk of your A-Fib episodes becoming more frequent and longer, often leading to continuous (Chronic) A-Fib. (However, some people never progress to more serious A-Fib stages.)
Fibrosis makes the heart stiff, less flexible and weak, reduces pumping efficiency and leads to other heart problems. The abnormal rhythm in your atria causes electrical changes and enlarges your atria (called remodeling) making it work harder and harder over time.
Don’t let your doctor leave you in A-Fib. Educate yourself. Any treatment plan for A-Fib must try to prevent or stop remodeling and fibrosis. And always aim for a Cure!
To learn more, read my editorial, Leaving the Patient in A-Fib—No! No! No!
Educate Yourself—and Always Aim for a Cure!
Any treatment plan for Atrial Fibrillation must address the increased risk of clots and stroke. By far the most commonly used medicine for stroke prevention is the anticoagulant warfarin (brand name Coumadin).
But warfarin is a tough drug to take long term with monthly blood tests and possible side effects. These are my top 5 articles to help you understand warfarin therapy, the associated risks and some of the alternatives.
Review these articles to learn more about Warfarin therapy:
Bonus: Video about Warfarin
Living with Warfarin: Patient Education
Excellent introduction to anticoagulant therapy with warfarin (Coumadin). Patients and medical professionals (clinical nurse, doctors, a pharmacist and clinical dietician) discuss the practical issues associated with taking warfarin. (16:22) Uploaded on Mar 7, 2011. Produced by Johns Hopkins Medicine.
An Alternative to Blood Thinners
Do you hate having to take Coumadin? Hate the monthly testing? Bothered by side effects? An alternative to taking blood thinners is closing off your Left Atrial Appendage (LAA) with the Watchman, an occlusion device. Learn more: The Watchman™ Device: The Alternative to Blood Thinners.
by Patti J. Ryan, October 2016
Called ‘Broken Heart Syndrome’, a new study finds that the death of a partner is linked to a heightened risk of developing atrial fibrillation. The risk seems to be greatest among the under 60s and when the loss of the partner was least expected.
The researchers looked at a national registry in Denmark of 88,612 people who were diagnosed with atrial fibrillation and 886,120 healthy people matched for age and sex, and between 1995 and 2014. Other factors that might influence atrial fibrillation risk were included as well.
They found that people who had lost a partner were 41% more likely to develop atrial fibrillation in the first month after losing their partner. The risk seemed to be greatest 8 to 14 days following a death and gradually subsided during the following year.
More Evidence of Mind-Heart Link
Experts suspect acute stress may directly disrupt normal heart rhythms and prompt the production of chemicals involved in inflammation.
This study adds evidence to the growing knowledge that the mind-heart link is a powerful association.
What can be done about this risk? The answer requires more research but may focus on the way the body deals with stress.
Recommended Reading: The Anatomy of Hope: How People Prevail in the Face of Illness, by Jerome E. Groopman.
Written by an oncologist and citing actual patient cases (mostly cancer), Dr. Groopman explores the role of hope in fighting disease and healing. Top scientists are interviewed who study the biological link between emotion and biological responses; the most relevant studies are reviewed.
The author shows how hope, belief and expectations can alter the course of our lives, and even of our physical body. HOPE works! (For more read my review on Amazon.com.)
Dr. Groopman Interview: Listen to an audio interview with The Anatomy of Hope author, Dr. Groopman on NPR’s Fresh Air program (recorded Sept. 2004; 20 min.)
by Steve S. Ryan, PhD
In 1966, the wide-screen movie Fantastic Voyage took viewers inside the human body by injecting a miniaturized submarine, its crew and a surgical team into the carotid artery. Their mission was to break up a clot and save the VIP patient. Traveling through the heart to the brain, reveals a world of dazzling color, a floating wonderland with huge red corpuscles, whirling globules, platelets and particles.
I had that same amazing experience when Dr. Joris Ector presented his incredible 3-D vision of a real heart. Just like when watching the movie, there were involuntary gasps and shocks as you felt what it was like to move through the heart.
And yes, we had to wear 3-D glasses! That’s got to be a first at an A-Fib conference.
Starting with the exterior of a beating heart, Dr. Ector, from the University of Leuven, Belgium, showed every possible 3-D angle.
Next, he peeled away the exterior to reveal the movement of the heart from the inside. Next, he whisked you inside the heart so fast that you almost got dizzy.
Particularly interesting was the trip through the left atrium into the Left Atrial Appendage (LAA) with its trabeculations (thick muscular tissue bands) which looked like columns in close-up.
In some ways, Dr. Ector’s presentation felt more real and comprehensive than watching footage of an actual heart beating. It was an astounding experience (just like watching Fantastic Voyage in 1966). (I wish I had an interior of the 3-D heart to share with you.)
Image credit: Fantastic Voyage movie still from Foresight Institute
If you find any errors on this page, email us. ♥ Last updated: Friday, October 7, 2016
Totally historic! The MAM 2016 symposium set important goals for shaping the future of A-Fib care and showed how the emphasis on a ‘Heart Team’ is moving the field of patient A-Fib care to a new level.
This first Multidisciplinary Arrhythmia Meeting (MAM) was held in Zurich, Switzerland Sept 15-16, 2016 and advocated for a team approach―EPs, Surgeons, and other healthcare professionals working together to better help the A-Fib patient.
Leading cardiologists and surgeons explained why they favored the hybrid surgery/ablation referred to by several terms: “hybrid simultaneous,” or “hybrid staged,” or “multidisciplinary sequential approaches”.
Interactive Hands-On Workshops and Live Surgery
MAM 2016 featured interactive workshops with hands-on experiences in EP ablation, Surgical Ablation, and Mechanical Exclusion of the Left Atrial Appendage (LAA). Included were working examples of clinicians, electrophysiologists and surgeons teaming up to better help A-Fib patients.
Observing via a live video feed, attendees watched Dr. Stefano Benussi and his colleagues perform a surgery of an A-Fib patient showing both the left side and right side approaches. (The patient had a huge amount of fat which first had to be cut away before the pericardium sac could be reached and cut into in order to access the heart and pulmonary veins.)
MAM 2016 Program and Faculty
The Multidisciplinary Arrhythmia Meeting was the brain child of the Course Director Dr. Stefano Benussi of the University Hospital Zurich, Switzerland. Course Co-Directors were Harry Crijins of Maastricht, the Netherlands and Firat Duru of Zurich, Switzerland.
The Program Committee and Scientific Faculty making presentations included 54 distinguished doctors from around the world including the famed inventor of the original Cox Maze operation, James L. Cox of Denver, USA. (The Cox Maze operation was the first treatment to make patients A-Fib free.)
A partial list of MAM 2016 participating doctors and countries:
• Manuel Castella, Barcelona, Spain
• Paolo Della Bella, Alberto Pozzoli, Claudio Tondo, Milan, Italy
• Karl Heinz Kuck, Andreas Metzner, Hamburg, Germany
• Bart van Putte, Utrecht, The Netherlands
• Malcolm Dalrymple-Hay, Guy Haywood, Plymouth, UK
• Joris Ector, Mark La Meir, Laurent Pison, Brussels, Belgium
• Hans Kottkamp, Diana Reser and many more from Zurich, Switzerland
• Gunther Laufer, Vienna, Austria
• Randal Lee, Bing Liem, Steve S. Ryan, California, USA
• Ju Mei, Shanghai, China
• Peter Mueller, Dipen Shah, Geneva, Switzerland
• Amiran Revishvili, Moscow, Russia
• Timo Weimar, Stuttgart, Germany
• Michael Zembata, Zabrze, Poland
Additional presenting doctors will be identified along with summaries of their individual presentations.
My presentation summaries will follow.
If you find any errors on this page, email us. ♥ Last updated: Monday, October 3, 2016
A-Fib reduces the amount of blood flowing to the rest of your body by about 15%–30% and can have damaging effects.
That’s because the upper parts of your heart (the atria) aren’t pumping enough blood into the lower chambers of your heart (the ventricles). At the same time, your heart is working progressively harder and harder.
Here’s what can happen to your heart if you choose to just ‘live with Atrial Fibrillation”:
Don’t Just Live With Your A-Fib
Don’t listen to doctors who advise you to ‘live with A-Fib’ and who prescribe a lifetime on medication. Get a second opinion, or even a third! Educate yourself.
Seek your A-Fib cure!
Background: The Hybrid approach is an unusual team effort and is complementary in nature: the Surgeon works on the outside of the patient’s heart and the Electrophysiologist on the inside of the same patient’s heart.
Hybrid Surgery/Ablation is becoming an increasingly important and effective strategy for highly symptomatic patients with persistent atrial fibrillation or longstanding persistent atrial fibrillation who have failed one or two catheter ablations, and for the patient with a significantly enlarged left atrium. (Read more: Hybrid Surgery/Ablation.)
Multidisciplinary Arrhythmia Meeting (MAM)
The goal of MAM is to improve interaction between cardiologists and surgeons through multiple examples of cooperation in dealing with Atrial Fibrillation. [Note: In the past, it’s been a rare occurrence for a surgeon to work with a cardiac electrophysiologist.]
Cardiologists and surgeons from leading institutions in Europe, the US and Asia will discuss their experiences with hybrid simultaneous, hybrid stages, and multidisciplinary sequential approaches, and report their results.
Reporting from Zurich in September: I’ve been invited to attend this first Multidisciplinary Arrhythmia Meeting (MAM) by the organizers. I’ll be reporting on the key presentations and writing summary reports for our A-Fib.com readers.
The harmful chemical compound, BPA, may have been removed from many plastic bottles and food packaging, but “BPA-free” products may not be much safer.
The BPA chemical replacements, BPS and BPF, can also leach into food and beverages and may have the same impact on the human body (heart problems, as well as cancer, infertility and other health issues).
BPA Replacement Linked to Arrhythmias in Female Rats
A study published in the Journal Environmental Health Perspectives (Seltenrich) shows that the chemical compound BPS has nearly identical impacts on the cardiovascular system of rats as those previously reported for BPA. Researchers reported a link between BPS and irregular heartbeat. More research is needed.
What to Do: It Doesn’t Hurt To Be Cautious
To reduce your risk of arrhythmia from BPS/BPF, decrease or eliminate your use of plastic storage containers for food or drink.
Drink from steel or glass containers, not plastic ones.
Don’t microwave your food in plastic containers. The heat from the microwave can separate BPA-like compounds from plastic containers, making them easier to ingest. If you must use plastic containers, avoid the microwave.
Ideally, just store food in ceramic, glass or stainless steel containers in the first place.
To read more, see the April 2015 TIME magazine article by Justin Worland, Why ‘BPA-Free’ May Be Meaningless.
by Steve S. Ryan, PhD, updated September 18, 2016
Few people in the U.S. today are shocked or scandalized that the Drug and Device Industry (DDI) basically bribes doctors and hospitals to prescribe their drugs or use their equipment. It’s so commonly done that we take it for granted.
In the U.S., in general, it isn’t considered unethical or immoral for doctors to accept payments or favors from the Drug and Device Industry (DDI). Nor is it illegal.
But soon U.S. patients will be able to simply type in our doctor’s name in the Open Payments Database and see how much they are being paid by the DDI and what conflicts of interest they have.
Thanks to the Sunshine Act (a provision of the U.S. 2010 Patient Protection and Affordable Care Act), the DDI must report when they make a payment to a doctor for meals, promotional speaking or other activities.
Influencing Doctors’ Prescriptions for the Price of a Meal
In a recent JAMA Internal Medicine report (DeJong, C., June 2016), the authors compared meal payments to doctors with the drugs they prescribed to Medicare patients.
Even doctors who accepted only one free meal were more likely to prescribe the brand name drug.
Not surprisingly, they found that physicians who accept free meals from a drug company are more likely to prescribe that company’s brand name drugs rather than cheaper (and usually more proven) generic drugs. This study only focused on physicians who received meals.
Even doctors who accepted only one free meal were more likely to prescribe the brand name drug. Doctors who accepted four or more meals were far more likely to prescribe brand name drugs than doctors who accepted no meals. Furthermore, doctors who accepted more expensive meals prescribed more brand name drugs.
In another related JAMA Internal Medicine report (Yeh, JS, June 2016), researchers found similar evidence that industry payments to physicians are associated with higher rates of prescribing brand-name statins.
Steer Clear of Conflicts of Interest
The publication, Bottom Line Personal, offered words of wisdom on this subject.
“Studies have found that when there is a conflict of interest, it is almost impossible for even well-meaning people to see things objectively.”
Dr. Dan Ariely of Duke University described how, if a doctor must choose between two procedures, they are likely to pick the one that has the better outcome for their bottom line.
“That doesn’t mean the doctor is unethical…it just means he is human. We truly seem to not realize how corrosive conflicts of interest are to honesty and objectivity.”
He advocates that we steer clear of people and organizations with conflicts of interest “because it does not appear to be possible to overcome conflicts of interest.”
Conflicts of Interest: Be Suspicious of Doctors
Doctors are only human. If a drug rep gets them great tickets to a sporting event, for example, of course they will be inclined to favor that rep’s drug. Whenever you visit a health/heart website ask yourself: “Who owns this site?” and “What is their agenda?”
Whenever you visit a health/heart website ask yourself: “Who owns this site?” and “What is their agenda?”
But be suspicious if your doctor tells you:
• to take an expensive new drug
• to just “live with your A-Fib”
• insists that catheter ablation is too dangerous or unproven
• that A-Fib can’t be cured
• that you have to take drugs for the rest of your life
If this happens to you, RUN and get a second opinion (and even a third opinion).
Conflicts of Interest: Be Suspicious of Health/Heart Websites
When I attend talks at most A-Fib conferences, the first slide a presenter shows is often a list of their Conflicts of Interest.
But this is not required of websites! Health/Heart websites are not required to be transparent and reveal their conflicts of interest.
Whenever you visit a health/heart website ask yourself: “Who owns this site?” and “What is their agenda?” (Hint: Check their list of “sponsors” and follow the money!)
Drug Industry Owns or Influences Most Heart/Health Web sites
The drug and device industry owns, operates or influences almost every health/heart related web site on the Internet!
The fact is most health/heart web sites are supported by drug companies who donate most of their funding.
For example, did you know that the drug company Ely Lilly partially owns and operates WebMD, the Heart.org, Medscape.com, eMedicine.com and many other health web sites?
The fact is that most health/heart web sites are supported by drug companies who donate most of their funding. Consider how that may affect the information they put on their web sites―they’re not going to bite the hand that feeds them.
Be Suspicious of A-Fib Info on the Internet
In our crazy world, you can’t afford to trust anything you read on the Internet.
At one time I tried to keep track of all the mis-information found on various A-Fib web sites. When we’d find something wrong, we would write the site. I don’t think we’ve ever received a reply. Finally, we gave up. (See my video: Buyer Beware of Misleading or Inaccurate A-Fib Information.)
Many web sites put out biased or mis-information. Be skeptical. You can tell if someone is trying to pull the wool over your eyes. Truth will out. If you feel uncomfortable or that something is wrong with a site, it probably is. When you find a good site, the truth will jump out at you.
In today’s world, you have to do your own due diligence. You know what makes sense and what doesn’t.
For more, see my article: EP’s Million Dollar Club—Are Payments to Doctors Buying Influence?
It’s early days for wearables in healthcare, but there’s a lot of potential.
In the near future, an Apple Watch or Android Wear could detect if the wearer is experiencing Atrial Fibrillation. A preliminary algorithm (app) to detect A-Fib has been developed by researchers at UCSF and engineers at Cardiogram, Inc.
The mRhythm Study: You Can Help Develop the Smart Watch App
The researchers need your help now. If you have an Apple Watch or Android Wear—regardless of whether you have A-Fib—you can contribute your data to help make the algorithm more accurate.
To Participate in the Study: Visit the mRhythm Study website and scroll down the page and look for ‘We Need Your Help.’ At the bottom of the page, you can then read answers to ‘Frequently Asked Questions’.
What This Means for Patients
Each year, more than 100,000 strokes are caused by A-Fib. But all too often, their A-Fib is “silent” with no obvious or noticeable symptoms. In these cases, their A-Fib is undiagnosed until they have a stroke. Only then do they find out they have A-Fib (…if they survive). About 50% will have a disabling stroke.
Apple Watch owners—regardless of whether you have A-Fib—you can contribute your data to help develop this app.
If the Smart Watch algorithm app works as intended, anyone with an Apple Watch or Android Wear will be alerted if they are experiencing Atrial Fibrillation.
For the undiagnosed, their A-Fib will be ‘visible’ and no longer be “silent.” They will know if they are at risk of an A-Fib stroke and can get the proper preventive treatment.
Today patients rely on an ECG in a doctor’s office or the use of a Holter monitor to detect A-Fib. Instead, a Smart Watch with the A-Fib app can extend a patient’s monitoring period to a year (between doctor’s visits) or on an on-going basis.
Amazing! Think of all the lives saved and debilitating strokes avoided! The A-Fib Smart Watch app has the potential to revolutionize the field of A-Fib monitoring.
Third in my series from the Ninth Annual Western Atrial Fibrillation Symposium held February 26-27, 2016 in Park City, UT. Read my other reports here.
If you have A-Fib, it’s important to realize that not all strokes are ‘A-Fib related’. You may be perfectly anticoagulated or have a Watchman Device installed and still experience a stroke.
Realize: an A-Fib patient can have a stroke that isn’t caused by A-Fib.
Dr. Jennifer Majersik of the Stroke Center of the Un. of Utah described the case of a man with A-Fib who had an ischemic stroke even though his INR on warfarin was in the correct range.
An A-Fib patient can have a stroke that isn’t caused by A-Fib. There are multiple mechanisms which can cause a stroke. Of the 690,000 strokes in the US/year nearly 1/3 are cryptogenic (of unknown cause) and of those 30% is caused by asymptomatic or Silent A-Fib.
In a recent study, 99% of subjects aged 65 or older had evidence of microbleeds; and closer examination of the cranial MRI images revealed an increased number of detectable microbleeds (i.e., the closer they looked, the more microbleeds they found).
Microbleeds in the brain are thought to be a precursor of hemorrhagic stroke.
Cerebral microbleeds (MBs) are small chronic brain hemorrhages of the small vessels of the brain.
If Microbleeds Cause Hemorrhagic Stroke, Should I be on a Blood Thinner?
The fact that almost everyone 65 or older has microbleeds is astonishing and worrisome, particularly if you have A-Fib and have to take anticoagulants. Anticoagulants cause bleeding. That’s how they work.
In plain language, this study indicates that cerebral microbleeds lead to or cause hemorrhagic stroke. It’s not surprising then that some doctors are reluctant to prescribe heavy-duty anticoagulants to older A-Fib patients.
Being older and already having microbleeds only makes taking anticoagulants all the more worrisome.
Risks of Taking Anticoagulants (Blood Thinners)
Taking almost any prescription medication has trade-offs. Older A-Fib patients find themselves between a rock and a hard place.
In the case of anticoagulants, on one hand you get protection from having an A-Fib stroke (which often leads to death or severe disability), but on the other hand you have an increased risk of bleeding.
For those over 65 who already have microbleeds, … Continue reading this report…->
Warren Welsh, from Australia, answers ‘Yes’ to that oral hygiene question. He wrote me about how he developed bleeding gums and felt it contributed to his Atrial Fibrillation diagnosis. (A 2010 catheter ablation made him A-Fib free. Read Warren’s story.)
Brush and floss regularly we were taught as kids, but who knew that oral hygiene is linked with A-Fib?
Dental Cleanings and New-Onset A-Fib
A study in Taiwan compared a group without A-Fib who received dental cleaning at least once a year to a similar group who didn’t. Both groups were followed for five years. The regular dental cleanings group had a lower occurrence rate of new-onset A-Fib.
More frequent dental visits (2-3 times a year) further reduced the risk.
Good Oral Hygiene Reduces Inflammation
Studies have shown that inflammation is an independent risk factor both for the initiation of A-Fib and its continuation once you have it.
Good oral hygiene prevents A-Fib, probably by reducing the amount of inflammation of the gums and periodontitis (gum disease).
Good oral hygiene reduces the risk of new-onset A-Fib and of sustaining it once you’ve got it.
For more about A-Fib and dental health, read my FAQ question about Local Anesthesia Used in Dentistry May Trigger Your A-Fib.