From the Guidelines
Not treating atrial fibrillation (AFib) poses significant risks, including a 3- to 5-fold increased risk of heart failure and stroke, and a 2-fold increased risk of all-cause mortality.
Risks of Untreated AFib
- Increased risk of ischaemic stroke, with a five-fold increased risk compared to sinus rhythm 1
- Increased risk of heart failure, with a 3-fold increased risk compared to sinus rhythm 1
- Increased risk of all-cause mortality, with a 2-fold increased risk compared to sinus rhythm 1
- Increased risk of thromboembolism, with a significant proportion of strokes attributed to AFib 1
Stroke Risk Assessment
The CHADS2 index is a commonly used tool to assess stroke risk in patients with nonvalvular AFib, with points assigned for prior stroke or TIA, age 75 years, hypertension, diabetes mellitus, and heart failure 1.
Importance of Anticoagulation Therapy
Anticoagulation therapy, such as warfarin, has been shown to reduce the risk of ischemic stroke by 62% in patients with AFib, and is recommended for patients at high risk of stroke 1.
Individualized Treatment Approach
Treatment decisions should be individualized, taking into account the patient's stroke risk, bleeding risk, and other comorbidities, with the goal of optimizing stroke prevention while minimizing the risk of bleeding 1.
From the Research
Risks of Not Treating Atrial Fibrillation (AFib)
The risks of not treating atrial fibrillation (AFib) include:
- Increased risk of stroke, heart failure, myocardial infarction, dementia, chronic kidney disease, and mortality 2, 3, 4, 5
- Higher rates of stroke and thromboembolic events, with an estimated risk of 2% or greater per year 2, 6
- Increased risk of all-cause mortality 3
- Hemodynamic instability, including decompensated heart failure 3
- Reduced quality of life, left ventricular systolic function, and cardiovascular outcomes, such as rates of mortality and heart failure hospitalization 2
Consequences of Undertreatment or Non-Treatment
The consequences of undertreatment or non-treatment of AFib include:
- Higher rates of nontreatment and undertreatment among patients with elevated stroke risk, ranging from 2.0-51.1% and 10.0-45.1%, respectively 6
- Preventable cardiovascular events and death 6
- Higher adverse events associated with all bleeding types, such as hemorrhagic stroke, major bleeding, or gastrointestinal hemorrhaging 6
- Increased healthcare resource utilization 6
Importance of Treatment
Treatment of AFib is crucial to reduce the risk of complications, including:
- Anticoagulation with a vitamin K antagonist or direct oral anticoagulant to reduce stroke risk by 60% to 80% compared with placebo 2
- Early rhythm control with antiarrhythmic drugs or catheter ablation to restore and maintain sinus rhythm 2, 3
- Lifestyle and risk factor modification to prevent AF onset, recurrence, and complications 2, 5