Doctors & patients are saying about 'A-Fib.com'...


"A-Fib.com is a great web site for patients, that is unequaled by anything else out there."

Dr. Douglas L. Packer, MD, FHRS, Mayo Clinic, Rochester, MN

"Jill and I put you and your work in our prayers every night. What you do to help people through this [A-Fib] process is really incredible."

Jill and Steve Douglas, East Troy, WI 

“I really appreciate all the information on your website as it allows me to be a better informed patient and to know what questions to ask my EP. 

Faye Spencer, Boise, ID, April 2017

“I think your site has helped a lot of patients.”

Dr. Hugh G. Calkins, MD  Johns Hopkins,
Baltimore, MD


Doctors & patients are saying about 'Beat Your A-Fib'...


"If I had [your book] 10 years ago, it would have saved me 8 years of hell.”

Roy Salmon, Patient, A-Fib Free,
Adelaide, Australia

"This book is incredibly complete and easy-to-understand for anybody. I certainly recommend it for patients who want to know more about atrial fibrillation than what they will learn from doctors...."

Pierre Jaïs, M.D. Professor of Cardiology, Haut-Lévêque Hospital, Bordeaux, France

"Dear Steve, I saw a patient this morning with your book [in hand] and highlights throughout. She loves it and finds it very useful to help her in dealing with atrial fibrillation."

Dr. Wilber Su,
Cavanaugh Heart Center, 
Phoenix, AZ

"...masterful. You managed to combine an encyclopedic compilation of information with the simplicity of presentation that enhances the delivery of the information to the reader. This is not an easy thing to do, but you have been very, very successful at it."

Ira David Levin, heart patient, 
Rome, Italy

"Within the pages of Beat Your A-Fib, Dr. Steve Ryan, PhD, provides a comprehensive guide for persons seeking to find a cure for their Atrial Fibrillation."

Walter Kerwin, MD, Cedars-Sinai Medical Center, Los Angeles, CA


7 Key Points of the new “2023 Guideline for the Diagnosis & Management of Atrial Fibrillation”

This is my second report on the new “2023 Guideline for the Diagnosis & Management of Atrial Fibrillation” published in January 2024. The updated recommendations was a collaborated effort by cardiologists, electrophysiologists, surgeons, pharmacists, patient representatives and other stakeholders. The Guideline was last updated in 2014 and supplemented in 2019.
In my first report, I wrote why the new Guideline is important to all A-Fib patients and covered a few of the important updates. It includes new evidence to guide your cardiologist and electrophysiologist in the treatment of your Atrial Fibrillation.

7 Key Points For Patients to Know

After writing my first report, I continued to study the Guideline (it’s 171 pages after all).

This second report contains several important key points that may influence how you interact with your electrophysiologist and cardiologist. And can affect your choice of which A-Fib treatment(s) is right for you.

To be an informed patient, the main points you should know are:

1. As before, catheter ablation is recognized as first-line therapy for most A-Fib patients.

What that means is that you no longer have to undergo months or a year on antiarrhythmic (drug) therapy before you can have a catheter ablation. Even if you’ve just been diagnosed with A-Fib, you can choose to have a catheter ablation as your first treatment option.

From the Guideline: “Catheter ablation is useful as first-line therapy to improve symptoms and reduce progression to persistent AF.”

“Early rhythm control is associated with a greater likelihood of maintaining sinus rhythm in the long term and minimizing AF burden and reducing the progression of the disease.” And it reduces the likelihood of dementia onset.

2. The Guideline emphasizes the use of catheter ablation (CA) early in the treatment of A-Fib. Studies show an early catheter ablation is beneficial particularly in patients with heart failure.

3. Warfarin is no longer a recommended anticoagulant. Direct oral anticoagulants (DOAC) are preferred over warfarin (with the exception of certain patients with, for example, a mechanical heart valve).

4. Aspirin is no longer recommended as an anticoagulant. “Aspirin…alone as an alternative to anticoagulation is not recommended to reduce stroke risk.”

5. The guideline recognizes that clots take time to form (e.g. “lasting ≥24 hours”). Before, it was thought that even a short A-Fib episode (less than 5 minutes) could cause a clot and stroke.

Under the new guideline, for most patients whose A-Fib episodes last less than 5 minutes should not receive Oral Anticoagulant.

6. Important recognition: The benefits of Left Atrial Appendage Occlusion devices (i.e., Watchman, Amplatzer, etc.) may be a reasonable alternative to an Oral Anticoagulant.

7. The Guideline recognizes that “A-Fib burden” (how severe your A-Fib is and how it affects you) is an important factor in the treatment of your A-Fib.

Read it Yourself

If you haven’t already read it, I recommend you read my first report.

Also, if you want to review the Guideline yourself, the entire document is on the The Journal American College of Cardiology website. It includes a Table of Contents so you can jump to and read a particular section. Footnotes are included and linked to a 32-page Reference section as well as Appendices.

You can also download a copy of the 171 page Guideline as in a .PDF document and review it at your leisure.

Research
• Crawford, Thomas E. et al. 2023 Guidelines for Diagnosis and Management of Atrial Fibrillation: Key Perspectives. American College of Cardiology, Nov. 30, 2023. https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2023/11/27/19/46/2023-acc-guideline-for-af-gl-af

• Joglar, Jose A. et al. 2023 ACC/AHA/ACCP/HRS Guidelines for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines Circulation Vol. 149, No.1. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001193

2024 AF Symposium: An Overview For Atrial Fibrillation Patients and Families

The 29th annual AF Symposium was held in Boston Feb. 1-3, 2024.

This is the 20th time I have attended the annual AF Symposium. Observing and adequately reporting on it is both a challenge and a privilege. I learn more in three days than in a year of reading A-Fib research reports.

This intense 3-day seminar featured presentations by 85 leaders in A-Fib Research and Clinical Practice from all over the world.

Click on image to read my full report.

These stellar medical scientists, clinicians, and researchers shared recent developments in the A-Fib field in a major scientific forum unmatched by any other conference. This year the Symposium attracted over 1200 participants from all corners of the globe.

Why I Attend Every Year

As always, I attend and write my reports to offer A-Fib.com readers the most up-to-date research and developments that may impact their treatment choices. All reports are written in plain language for A-Fib patients and their families. (Look for more of my reports in the coming weeks and months.)

Exciting Breakthroughs: A New World of A-Fib Care

The predominant mood or tone of this year’s Symposium was one of excitement about the extraordinary amount of new and more effective tools now (or soon to be available) to Electrophysiologists (EPs) for treating us patients.

To me the sheer number of new catheters, devices, etc. presented was almost overwhelming. As Dr. Pierre Jais of the French Bordeaux group (LYRIC) said, this a “great era!” There is now an incredible number of new tools EPs can choose from.  -> click to read my full report.

First-Time Catheter Ablation for Atrial Fibrillation Safer Than Ever

For patients with symptomatic A-Fib, catheter ablation is a commonly performed procedure. However, it does have potential complications. As with any procedure, the informed patient needs to know the risk factors.

To determine the most recent complication rates, researchers did a systematic review and pooled analysis of 89 studies from the past 10 years. Their results were published in May 2023.

Research Methods 

EDLINE and EMBASE databases were searched from January 2013 to September 2022 for randomized control trials that included patients undergoing a first ablation procedure using either radiofrequency or cryoballoon.

A total of 89 studies met inclusion criteria. A total of 15,701 patients were included in the current analysis.

By comparison, the complication rate for the common appendectomy is around 18%.

Survey Findings

Vascular complications (i.e., bleeding and clotting) were the most frequent type of complication (1.31%).

The next most common complications were pericardial effusion/tamponade (i.e., fluid buildup around the heart) (0.78%) and stroke/transient ischemic attack (blood clot to the brain) (0.17%).

During the 10-year period of the analysis, procedure-related complication rates were:
• Overall 4.51%
Severe  2.44%

Comparing the earlier 5-year period to the most recent 5-year period, complication rates were:
• Earlier period: 5.31%
• Most recent period: 3.77%.

Over the 2 time periods, mortality rates were stable.

There was no significant difference as to pattern of A-Fib, ablation technique, or ablation strategies beyond the pulmonary vein isolation.

Researchers Conclusions

When you see the term “catheter ablation” it’s shorthand for pulmonary veins ablation (PVA).
Procedure-related complications and mortality rates associated with A-Fib catheter ablation are low.

Complication rates have declined in the past decade (2013-2022).

A significant improvement in the safety of the procedure was observed over the last 5 years (2018-2022).

Neither the type of energy used for ablation nor the creation of additional lesions in addition to the pulmonary veins significantly influenced the procedural complication rate.

Editor's CommentsWhat This Means for A-Fib Patients

One of the drawbacks of these findings from a patient’s perspective it that it doesn’t differentiate between major and minor complications.

All Complications Are Not Equal: For example, vascular complications (such as bruising or bleeding at the catheter insertion points) are usually minor and easily taken care of with no lasting consequences.

More serious complications are:

Tamponade: Blood can bleed into the pericardium sac that surrounds the heart compressing it. Most centers and Electrophysiologists (EPs) are well aware of this and can move swiftly to drain off the extra blood.

Atrioesophageal Fistula: This is a very rare complication (less than 1 in 1000) but one which can kill you. When a catheter makes an RF burn (lesion) near the esophagus, the heat may damage the esophagus wall which can later be eroded by gastric acids allowing blood to leak into the esophagus. Most centers and EPs now take extensive precautions to prevent this. (The new technology, Pulse Field Ablation, virtually eliminates this complication, see Pulsed Field Ablation—Emerging Tech for Atrial Fibrillation)

Stroke: During a catheter ablation you are on heavy-duty anticoagulants so strokes are rare (0.17%). But as with anyone with A-Fib, strokes can occur.

In this analysis of 89 studies the overall major complication rate was very small.

First-Time Catheter Ablation: The bottom line for us patients is that first-time catheter ablation (PVA) is one of the safest procedures you can have in a hospital. (FYI: By comparison, the complication rate for the common appendectomy is around 18%.)

In practice, for most A-Fib patients, the actual risks are so small that it’s safer getting a PVA than not getting one.

A PVA is safe and afterwards certainly feels a lot better than a life in A-Fib and/or a life on antiarrhythmic drugs and anticoagulants. One reason people get a PVA is so that they don’t have to live the rest of their lives on these drugs.

When choosing to have a catheter ablation, make the effort to find high volume operators and experienced hospitals.

Catheter Ablation is Considered a Low-Risk Procedure: Over 1 million catheter ablations are performed annually in the U.S.

The complication rate has continued to decrease.  In this analysis a significant improvement in safety was observed over the last 5 years.

But Beware of Low-Volume Operators: As patients we need to be aware that complications come mostly from low volume operators (those who perform less than 25 ablations a year), and that 81% of all ablations are performed by low volume operators.

This is important! When choosing to have a catheter ablation, make the effort to find high volume operators and experienced hospitals.

Research
Benali K, Khairy P, Hammache N, et al. Procedure-Related Complications of Catheter Ablation for Atrial Fibrillation. J Am Coll Cardiol. 2023 May, 81 (21) 2089–2099. https://doi.org/10.1016/j.jacc.2023.03.418

New “2023 Guideline for the Diagnosis & Management of Atrial Fibrillation”

Links updated: 12-21-23

Important for all A-Fib patients: The newly issued 2023 Guideline for the Diagnosis and Management of Atrial Fibrillation. The guideline includes new evidence to guide your cardiologist and electrophysiologist in the treatment of your Atrial Fibrillation. It was last updated in 2014 and supplemented in 2019.

Cardiologists, electrophysiologists, surgeons, pharmacists, patient representatives and other stakeholders all collaborated on the updated recommendations.

First issued in 1980, the American College of Cardiology (ACC) and the American Heart Association (AHA) develop and publish these guidelines without commercial support, and members volunteer their time to the writing and review efforts.

ACC/AHA develop and publish these guidelines without commercial support, and members volunteer to write and review them.

ACC/AHA/ACCP/HRS: The 2023 Guideline is endorsed by four medical organizations: American College of Cardiology (ACC), American Heart Association (AHA), American College of Clinical Pharmacy (ACCP), and Heart Rhythm Society (HRS).

A Few of the Important Updates for Patients: I am still reading/studying this document—it’s 171 pages long. Here are a few updates that reflect important shifts in the treatment of A-Fib patients:

• Stages of atrial fibrillation: recognizes A-Fib as a disease continuum that requires a variety of strategies at the different stages;
• A-Fib risk factor: recognizes lifestyle and risk factor modification as a pillar of A-Fib management to prevent onset and progression;
• Catheter ablation of A-Fib: can be first-line therapy; Recognizes the superiority of catheter ablation over drug therapy for rhythm control;
• Left atrial appendage occlusion devices: recognized for safety and efficacy.

Steve Ryan at the 2023 AF Symposium

If you read A-Fib.com regularly, you know these topics have filled my posts for years. I write about these topics after reading the newest research, evidence and findings, querying the experts and learn the latest innovations at the annual AF Symposiums from presentations by leading electrophysiologists, cardiologists, scientists and researchers (read my 2023 AF Symposium posts).

I’ll write more about these changes.

You Can Read it Yourself. It’s available on the websites of the American College of Cardiology (JACC.org) and the American Heart Association (ahajournal.org).

Newly released: 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines; Issued by American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines; See www.jacc.org or www.aha.org.

 

A-Fib Patients: Know Your Risk During Non-Cardiac Surgeries

For patients with Atrial Fibrillation, any surgery is riskier than for patients without A-Fib. That’s the finding of a 2022 study.

In a study from the Cleveland Clinic, patients with A-Fib undergoing non-cardiac surgery were associated with higher risks of mortality, heart failure, and stroke.

“Non-cardiac Surgery” means any surgery that doesn’t involve the heart.

Study Parameters: Non-cardiac surgery was classified as vascular, thoracic, general, genitourinary, gynecological, orthopedics and neurosurgery, breast, head and neck, and transplant. (Basically any major surgery not involving the heart.)

Participants included 8,635,758 Medicare patients admitted from 2015 to 2019 for various surgeries not involving the heart (non-cardiac surgery). Out of this number of patients, 16.4% of patients had A-Fib at the time of their surgery.

For patients with Atrial Fibrillation, any surgery is riskier than for patients without A-Fib.

Focus of the Study: Did post-surgery adverse events differ for A-Fib patients compared to the other participants?

Findings: The study found that pre-existing A-Fib is independently associated with postoperative adverse outcomes after surgery. These include increased risk of stroke, heart failure and other heart-related complications.

Editor's CommentsEditor’s Comments

Established Protocols: There are well established and known protocols to prevent, diminish or neutralize A-Fib when undergoing noncardiac surgery. The researchers, Waterford and Ad, state that preoperative oral amiodarone is the single most powerful intervention to dramatically reduce rates of POAF.
They recommend 400 mg oral amiodarone per day for 3 days prior to surgery, followed by 200 mg per day for 10 days through and following the operation regardless of whether or not POAF developed. It’s recommended that a patient be on a beta-blocker or a statin whenever possible.
Ideally, Become A-Fib Free Before the Surgery: If you have A-Fib and have to undergo non-cardiac surgery, try to become A-Fib free before the surgery. (This is even more important if undergoing cardiac surgery such as bypass).
Medication Adjustment: Even if you can’t have a catheter ablation, your EP can often adjust your meds so that you are A-Fib free at the time of the noncardiac surgery.
Proper Pre-Op Treatment: If it isn’t possible to be A-Fib free before the your surgery, make sure your surgeon knows about and uses protocols to prevent and diminish the effects of A-Fib on non-cardiac surgery. See Having Surgery? Post-Operative A-Fib & Protocols to Prevent it.
Be Insistent! Be Assertive! Be aware that many surgeons (and their staff) don’t know about or use these protocols.
If you’re told by the surgeon’s office staff to “Don’t worry about that.” or “The surgeon is very experienced,” don’t settle for platitudes.
You may have to be very assertive with your surgeon to make sure they understand your concerns and treat you properly before the surgery.

It’s Okay to Fire Your Surgeon: If your surgeon won’t work with you, there are many surgeons who will. It’s okay to fire your surgeon, and find another one who will address these concerns.

References
• Prasadam S. et al. Preoperative Atrial Fibrillation and Cardiovascular Outcomes After Noncardiac Surgery. JACC Journals, Vol. 79 No. 25. https://www.jacc.org/doi/10.1016/j.jacc.2022.04.021

• Waterford and Ad. 7 Pillars of Postoperative Atrial Prevention. Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery. Editorial. November 25, 2021. https://pubmed.ncbi.nlm.nih.gov/34823388/ doi: 10.1177/15569845211043485.

Research: Use of Illicit Drugs and Risk of Developing A-Fib

We are living in a time when law makers are considering more lenient laws on the use of illegal drugs. One unexpected effect of this shift may lead to more people developing Atrial Fibrillation.

Observational Research

This observational study used databases of the California Office of Statewide Health Planning and Development. The study included all adults in California from 2005 to 2015 who were A-Fib free at the time and received care in an emergency room department, same-day surgery unit, or hospital.

In this large, long-term study over 23 million patients were included. Of this study population 98,000+ used methamphetamine, 48,000+ used cocaine, 10,000+ used opiates, and 13,200+ used cannabis.

The researchers analyzed associations between the use of each substance and a new diagnosis of atrial fibrillation.

Risk Findings

Researchers found use of illicit drugs (methamphetamines, cocaine, opiates, and cannabis) was associated with a higher risk of developing atrial fibrillation compared with other known risk factors.

Of the total study population, over 998,000 patients (4.2%) developed Atrial Fibrillation during the 11-year study.

By Drug: Methamphetamine use nearly doubled the risk of developing A-Fib (86% increased risk). The corresponding increased risk for opiates, cocaine, and cannabis were 74%, 61%, and 35%, respectively.

By Multiple Drug Use: The researchers also investigated the impact of the number of drugs and frequency of use. Participants using two or more illicit drugs were 63% more likely to develop A-Fib than single drug users. The risks were basically the same for habitual versus occasional users.

Researchers Conclusion

Users of illicit drugs were at substantially greater risks of atrial fibrillation compared to non-users.

“This was the first large, long-term study examining the relationship between methamphetamines, cocaine, opiates, cannabis and atrial fibrillation,” said study author Professor Gregory Marcus of the University of California, San Francisco, U.S.

All four drugs were associated with higher risks of developing atrial fibrillation than many conventional risk factors including high cholesterol and diabetes. This indicates that avoiding these substances could help prevent the condition.

Editor's Comments

Editor’s Comments

The results of this observational study are very clear. If you take illicit drugs, your risk of developing A-Fib increases significantly.
This was a substantial study—over 23 million patients and long-term—over 10 years. The findings have important implications.
Professor Marcus offers this warning. “As some regions take steps towards legalizing recreational cannabis and adopting more lenient laws on the use of other illicit drugs, our research suggests caution and the importance of disseminating information on the potential harms.”

When considering less stringent control of these four drugs, legislators need to consider the personal and fiscal impact of more people developing Atrial Fibrillation.

References
• Marcus, Gregory. Illicit drugs linked with serious heart rhythm disorder. European Heart Journal, European Society of Cardiology, Oct. 18, 2022. https://www.escardio.org/The-ESC/Press-Office/Press-releases/illicit-drugs-linked-with-serious-heart-rhythm-disorder

• Lin, A L, et al. Cannabis, cocaine, methamphetamine, and opiates increase the risk of incident atrial fibrillation, European Heart Journal, Volume 43, Issue 47, 14 December 2022, Pages 4933–4942, https://doi.org/10.1093/eurheartj/ehac558

A-Fib and Sleep Apnea: At-Home Testing Approved by FDA

Many patients with Atrial Fibrillation also suffer with obstructive sleep apnea (OSA). Diagnosis of OSA and its treatment is essential if you have A-Fib.

What is OSA?

If you have sleep apnea, relaxation of throat muscles combine with a narrowed airway to interrupt breathing. The episodes of breathing cessation can last more than twenty seconds (reducing oxygen to the brain).

Nearly 22 million Americans suffer from sleep apnea, and more than half of cases go undiagnosed.

In-Lab Testing

To determine if you have obstructive sleep apnea (OSA), you must be tested.

Conventional testing for sleep apnea has been done at a sleep lab at a medical center or facility. You have a dozen or so electrical sensors attached to your body. You then try to sleep in a hospital-like environment. The people doing the testing may interrupt you during the night. At the end of the testing (at 6 am), you don’t feel rested at all.

At-Home Testing for Sleep Apnea Approved by the FDA

Home testing was FDA approved in 2022 and available by prescription.

A home sleep apnea test is an overnight, unattended study performed in the comfort of your own home. You pick up the kit or it is mailed to you.

While not as detailed as an in-clinic sleep study (it only measures breathing, not actual sleep), at-home sleep apnea testing can be used to diagnose or monitor obstructive sleep apnea (OSA).

At-home sleep apnea tests are best suited for people who are suspected of having moderate to severe sleep apnea that isn’t complicated by other disorders.

Home testing is available by doctor prescription. There are some testing companies who offer their own physicians to evaluate your test results. (If you don’t have a prescription, I wonder if the cost is covered by the patient’s health insurance.)

Home Testing Not for Everyone

For those with a more severe sleep apnea, an in-lab sleep experience may be required to rule out other medical conditions. Unlike a home sleep test, which looks only for sleep apnea, an overnight sleep study checks for conditions like insomnia, restless legs syndrome, periodic limb movements disorder, narcolepsy, and sleepwalking.

Editor's Comments

Editor’s Comments:

Personal experience: My wife, Patti, has had sleep apnea for years (but not A-Fib). She’s had in-labs testing and last October 2022 had an at-home sleep apnea test. I went by a UCLA facility to pick up the kit for her.
She carefully read the instructions and watched a how-to YouTube video by her healthcare provider. She set it all up and slept through the night quite comfortably (She’s been sleeping with a CPAP (Continuous positive airway pressure) facemask for years.) I returned the kit the next day. The results were then sent to her doctor.

Home-testing option: The at-home testing for Sleep Apnea may be a major advance in treating A-Fib. It may now be much easier, faster, (and perhaps cheaper) to test for Sleep Apnea which is one of the most common causes or symptoms of A-Fib (comorbidity).

Everything you need to know about sleep apnea and A-Fib, see our infographic.

References
• What to Know About an At-Home Sleep Test. Johns Hopkins Medicine/Health. https://www.hopkinsmedicine.org/health/wellness-and-prevention/what-to-know-about-an-at-home-sleep-test

• Benisek, A. Home Sleep Tests: What to Know. WebMD. June 16, 2022. https://www.webmd.com/sleep-disorders/home-sleep-tests-what-to-know

• Davies, C. et al. A single H-arm, open-label, multi-center, and comparative study of the ANNE sleep system versus polysomnography to diagnose obstructive sleep apnea. J Clin Sleep Med. 2022 Aug 8. Online ahead of print. https://pubmed.ncbi.nlm.nih.gov/35934926/ doi: 10.5664/jcsm.10194.

 

Study Measures Cognitive Impairment/Dementia in Individuals over 65

My personal experience with dementia: My mother-in-law lived a great life till age 100. She was a grade school teacher with a Master’s degree, a championship bridge player and did the crossword puzzles in ink! But in her last 5 years her short-term memory deteriorated until all was lost. (Thankfully, due to her long-term memory, she still knew all of us.)

I wrote recently about studies documenting that A-Fib leads to or causes dementia. How A-Fib doubles the risk of dementia. And that there’s a direct cause and effect relationship, independently relating A-Fib to cognitive decline and dementia.

In 2021, about 6.2 million U.S. adults aged 65 or older lived with dementia.

Study Measures Cognitive Impairment in Individuals or 65

In a 2016 national study, 3,496 individuals over age 65 completed a comprehensive neuropsychological test battery and informal interview to determine if they had Dementia and/or Mild Cognitive Impairment (MCI).

Mild cognitive impairment (MCI) is a condition in which people have more memory or thinking problems than other people their age.

This nationally representative cross-sectional study found that approximately one-third of 3496 individuals 65 years and older had dementia or MCI. (10% were classified as having dementia; 22% were classified as having mild cognitive impairment.)

The results were similar to other US-based studies.

Prevalence of Dementia

No differences were found between females and males (though 60% of the participants in the study were female). But prevalance did vary by age, education, and race and ethnicity.

Age Increases Risk of Dementia: Every 5-year increase in age was associated with a higher risk of dementia.

What Decreases Risk? Each year of education was associated with a decrease in risk of dementia and MCI.

Dementia vs. MCI by Race: Dementia was more common among Black individuals, while mild cognitive impairment was more prevalent among Hispanics.

These findings are from the first representative study of cognitive impairment in more than 20 years.

There is Good News

In the U.S., the prevalence of dementia is declining among people over age 65, dropping 3.7 percentage points from 2000 to 2016, according to a new RAND Corporation study.

The age-adjusted prevalence of dementia declined from 12.2 percent of people over age 65 in 2000 to 8.5 percent of people over age 65 in 2016—a nearly one-third drop from the 2000 level.

Editor's CommentsEditor’s Comments

These are sobering, frightening statistics especially for us as we get older. One-third of those over 65 were found to some form of dementia.
That’s something none of us wants to experience.
How can those with A-Fib reduce their chance of developing Early Onset Dementia? Don’t stay in A-Fib! Do everything you can to become A-Fib free.
Don’t just “manage” your A-Fib. Don’t learn to live with it. Don’t settle for a life on drugs. Seek your cure!

For more reading about Dementia, see: A-Fib and Dementia: My Top 5 Articles

Research
• George, Judy. Dementia Strikes One in Ten Americans Over 65. MedPage Today, October 24, 2022. https://www.medpagetoday.com/neurology/dementia/101395

• Manly JJ, et al. Estimating the Prevalence of Dementia and Mild Cognitive Impairment in the US: The 2016 Health and Retirement Study Harmonized Cognitive Assessment Protocol Project. JAMA Neurol. 2022;79(12):1242–1249. doi:10.1001/jamaneurol.2022.3543

• Hudomiet, P., et al. Trends in inequalities in the prevalence of dementia in the United States. PNAS, November 7, 2022. 119 (46) e2212205119. https://doi.org/10.1073/pnas.2212205119

 

Bleeding From Anticoagulants—All Anticoagulants are Dangerous

No one likes to take anticoagulants. They are inherently dangerous.

Drug therapy with oral anticoagulants in patients with atrial fibrillation is based on finding the ideal balance of effectiveness versus safety of these drugs.

In real-world clinical practice, bleedings were the most typical and common adverse events from treatment with oral anticoagulants (NOACs). Data from observational studies are an additional source of information for the adverse events (AEs) that come from taking anticoagulants.

Bleedings were the most typical and common adverse events from treatment with oral anticoagulants (NOACs).
One observational study, “ANTEY”, is a study from Russia that followed 186 A-Fib patients taking anticoagulants. The study reported 55 adverse events (AEs). There were 25 serious events, including 4 deaths.

The incidence of bleeding of those treated with NOACs was approximately 8% to 9%. (The bleeding risk with warfarin, was much higher.)

How Anticoagulants Decrease Your Risk of Blood Clots and Stroke

To decrease your risk of blood clots and stroke, anticoagulants hinder the clotting ability of your blood. The result is anticoagulants can cause or increase bleeding. That’s how they work.

In addition, they increase your risk of microbleeds in the brain, hemorrhagic stroke, early dementia, and gastrointestinal bleeding.

“Oral anticoagulants are high-risk medications” (Drs. Witt & Hansen).

Alert to Anyone Taking Anticoagulants

This study from Russia is another Red Flag alert for anyone taking anticoagulants.

It’s like playing Russian Roulette with your health. One out of ten times you’re at risk of a bullet to the brain (i.e., 8%-9% risk of Adverse Events when taking anticoagulants).

None the Less, Anticoagulants Do Reduce Your Chance of Stroke

But in spite of the possible negative effects of anticoagulants, if you have A-Fib and are at real risk of stroke, anticoagulants do work.

You’re no longer 4–5 times more likely to have an A-Fib (ischemic) stroke. Taking an anticoagulant to prevent an A-Fib stroke also may give you peace of mind.

If You Have A-Fib, Can You Safely Stop Taking Anticoagulants?

Never just stop taking your anticoagulant or reducing the dosage. That’s a decision for you and your doctor.

Yes! The best way to deal with the increased risk of stroke and side effects of anticoagulants is to no longer need them.

Here are three options:

#1 Alternative: Get rid of your A-Fib

As EP and prolific blogger Dr. John Mandrola wrote: “…if there is no A-Fib, there is no benefit from anticoagulation.”

Action: Request a catheter ablation procedure. Today, you can have an ablation immediately (called ‘first-line therapy’). You don’t have to waste a year on failed drug therapies. See Catheter Ablation Reduces Stroke Risk Even for Higher Risk Patients

#2 Alternative: Close off your Left Atrial Appendage (LAA)

The Left Atrial Appendage is where 90%-95% of A-Fib clots originate. Close off your LAA and you may no longer need to take an anticoagulant.

Action: Request a Watchman occlusion device. The Watchman device is inserted to close off your LAA and keep clots from entering your blood stream. See Watchman Better Than Lifetime on Warfarin

#3 Alternative: Consider non-prescription blood thinners

Ask your doctor about your CHA2DS2-VASc score (a stroke risk assessor). If your score is a 1 or 2 (out of 10), you are at low risk of having a stroke. You may not need to take an anticoagulant at all.

Action: Ask your doctor if you could take a non-prescription approach to a blood thinner. Perhaps you can benefit from an increase in natural blood thinners such as turmeric, ginger, vitamin E or, especially, the supplement Nattokinase. See FAQ: “Are natural blood thinners as good as prescription blood thinners?”  (Only change your medication under your doctor’s supervision.)

What this Means for A-Fib Patients

Bleeding from taking anticoagulants is a serious side effect. Drug therapy with oral anticoagulants  is based on finding the ideal balance of effectiveness versus safety of these drugs.

Perhaps the best balance may be to avoid needing anticoagulants in the first place:

Your options: Seek your A-Fib cure, i.e., get rid of your Atrial Fibrillation. Reduce your risk of stroke by closing off your Left Atrial Appendage. Or seek a non-drug natural blood thinner option to taking an anticoagulant.

References
• Martsevich, S. Y. et al. Analysis of Adverse Events in the Treatment of Patients with Non-Valvular Atrial Fibrillation with Oral Anticoagulants: Data from the “ANTEY” Observational Study. Pharmaceuticals. 2022, 13, 1209, MDPI. https://pubmed.ncbi.nlm.nih.gov/36297321/

• Witt, Daniel W. and Hansen, Alisyn L. New Oral Anticoagulants Can Require Careful Dosing Too. by Scott Baltic. Editorial, Medscape/Reuters Health Information, December 29, 2016. http://www.medscape.com/viewarticle/873821?src=wnl_edit_tpal

 

Magnesium Works in ERs to Reduce Risk of A-Fib or Return to Normal Sinus Rhythm

In the United Kingdom, it is common practice in critical care (E.R.) to administer serum magnesium to prevent A-Fib or to return patients to normal sinus rhythm.

This isn’t commonly done in the U.S.

UK ER Study: Magnesium Used in the ER to Prevent A-Fib

Research published in 2022 describes a study done of an adult critical care unit/emergency department (casualty) at the University College London Hospital between January 2016 and December 2017.

This single center observational study examined the preferences of critical nurses using Mg in patients who had undergone non-cardiac surgery.

Of 9,114 opportunities to administer intravenous Magnesium (Mg), there were significant variation practices depending on the individual nurses.

But still, intravenous Mg was associated with a 3% decrease in the relative risk of getting A-Fib after non-cardiac surgery.

Austrian ER Study: IV Magnesium Returns Normal Sinus Rhythm

A study from Vienna, Austria, looked at 2,546 episodes of non-permanent A-Fib in the emergency room (ER). Admission of Intravenous Magnesium (145.8 mg) and Potassium (24 mEq) were compared to no administration of either supplement.

Researchers found that Intravenous Magnesium and Potassium was associated with increased odds of returning patients to normal sinus rhythm (19.2% vs 10.4%) (but didn’t affect A-Flutter.)

Editor's CommentsEditor’s Comments

Though the above studies differ, they both show that administering Intravenous Magnesium in the ER is an effective tool in avoiding A-Fib or in returning A-Fib patients to normal sinus rhythm.
Some ERs in the U.S. do use Magnesium to return patients to normal sinus rhythm. (But many doctors still consider Magnesium [and most supplements] as little more than snake oil.)
This research is encouraging and indicates that Magnesium can be a useful tool with critical care patients. More research is needed.
What This Means for A-Fib Patients: If you wind up in the emergency room or urgent care for your Atrial Fibrillation, ask if they intend to administer  an IV of Magnesium. (If not, why?)

For more about Magnesium, see my article, Cardiovascular Benefits of Magnesium: Insights for Atrial Fibrillation Patients.

References
• Cacioppo, F. et at., Association of Intravenous Potassium and Magnesium Administration With Spontaneous Conversion of Atrial Fibrillation and Atrial Flutter in the Emergency Department. JAMA Network Open. 2022;5(10):e2237234.

• Wilson, M.G. et al. Clinical preference instrumental variable analysis of the effectiveness of magnesium supplementation for atrial fibrillation prophylaxis in critical care. www.nature.com/scientificreports. (2022) 12:17433. https://doi.org/10.1038/s41598-022-21286-1.

 

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