More Australians are going to hospital with atrial fibrillation – often jauntily known as a heart flutter – than any other cardiovascular conditions, according to a new study published in the journal Heart.
Atrial fibrillation and atrial flutter are not simply irregular heartbeats. They’re very fast electrical discharges that make the upper chambers of the heart (atria) contract very rapidly.
In some instances, the blood in the atria stagnates, and then clots. With nowhere else to go, the clot – usually large – moves through the heart and into one of the large arteries that goes to the brain.
Associated strokes are severe, even lethal
The result is a severe stroke with a greater chance of prolonged disability or death. Researchers from the South Australian Health and Medical Research Institute’s Centre for Heart Rhythm Disorders analysed data from all Australian hospitals across a 21-year period from 1993 to 2013.
They found the number of atrial fibrillation (AF) hospitalisations has essentially quadrupled (295 per cent) – while hospitalisations for heart attack and heart failure increased by 73 and 39 per cent respectively.
The raw numbers paint a clearer picture.
In 1993, there were 15,555 AF admissions.
In 2013, there were 61,424.
By comparison, in 1993 there were 31,193 myocardial infarction admissions, and 38,700 heart failure admissions.
In 2013, there were 54,116 and 53,643 admissions respectively.
Heart failure was once the leading cause for cardio-related admissions.
It’s now in third place.
Damning evidence of an unfit nation
Lead author and PhD candidate Celine Gallagher said the costs associated with AF hospitalisations have grown 479 per cent over the 16-year period leading up to 2014, compared to a 210 per cent increase for hospitalisations due to heart attack and heart failure.
But it’s the “relentless” rise of AF that should have this country worried – because it cuts across all age groups, and it provides brutal evidence as to how fat and unfit we’ve become.
What’s driving this massive onset of atrial fibrillation are the all-too-common plagues of modern living: obesity or simply carrying too much weight, too little exercise, and diabetes.
As Ms Gallagher told The New Daily: “We think that the adverse trends we’ve seen in many cardiovascular risk factors is driving an increase in developing AF in the first place.”
“We know that rates of individuals with high blood pressure has gone up. Rates of people being overweight, obese, living with diabetes … these are all risk factors for developing AF.”
Symptoms vary across individuals
“Most common symptoms are palpitations, shortness of breath, dizziness, chest pains and fatigue,” Ms Gallagher said.
“What we also know is that a significant number of people don’t have symptoms at all.”
Often the disorder is found incidentally during a visit to a GP.
“Your pulse is irregular, you are sent for [a scan]. If the diagnosis is made, then you’re referred to a cardiologist,” said Ms Gallagher.
“But given the risk of a severe stroke associated with AF, it’s important to be diagnosed sooner than later.”
Atrial fibrillation isn’t reversible: it’s a chronic condition.
“Although good management and addressing the lifestyle factors can lead to people being taken off their medication.”
Ms Gallagher said it was possible that better outpatient management of the condition might reduce hospitalisations – “as we teach people to manage their conditions better”.
She feels two things need to happen if the growth of AF onset and hospitalisations is to be abated “because it will only continue to grow”.
Under 50 and ailing
The first is to reduce the amount of people getting the condition in those in which this is possible – with better control of cardiovascular risk factors at a population level.
“You can’t control ageing which is also a risk factor,” she said.
Secondly, better outpatient management for individuals who have the condition, using a multidisciplinary approach, so people are aware of what to do if recurrent episodes occur.
She said the increase of AF admissions for people under 50 had been growing steadily at 4 per cent – “every year, for 21 years. And there’s no indication that’s slowing down”.
Clinical Manager, Policy and Evidence for the Heart Foundation Cia Connell said in an email the new study captured the healthcare costs associated with atrial fibrillation.
“However, this understates the full economic cost of the disease,” Ms Connell said.
“In 2008-09 the total economic cost of AF was estimated to be $1.25 billion in 2008-09, with healthcare expenditure responsible for just under 70 per cent of the total cost to the Australian economy.”
She said overall, the incidence of AF increasing in Australia was a result of an ageing population, and an increase in the risk factors for atrial fibrillation which include high blood pressure, obesity, and diabetes.
The Heart Foundation recommends anyone over 65 years old be screened by their doctor for AF.
The Heart Foundation recommends an integrated care approach for AF, delivered by multidisciplinary teams, including patient education and the use of eHealth tools and resources where available.