**EP12: An Introduction to Atrial Fibrillation**
**Dr. Warwick:** Welcome to Dr. Warwick's podcast channel. Warwick is a practicing cardiologist and author with a passion for improving care by helping patients understand their heart health through education. Warwick believes educated patients get the best health care. Discover and understand the latest approaches and technology in heart care and how this might apply to you or someone you love.
Hi, welcome to my consulting room. Today, I'd like to talk about atrial fibrillation, and by way of introduction, I'd like to tell you a story about my grandmother from back in 1994. My grandmother was in her early 80s. She had been wheelchair-bound since her mid to late 40s predominantly, and as her 80s approached, she was in the wheelchair pretty well all the time. She'd had congenital dislocation of her hips from childbirth. She had cardiac failure, diabetes, and Paget's disease, which affected some of the major bones within her body, but also her head. She had cataracts, so she couldn't see very well. She had severe deforming rheumatoid arthritis that she had had for years, and this caused considerable distress.
Around about 1994, she ended up going to the local hospital, generally unwell. She'd acquired pneumonia. As part of that time in the hospital, she was really very sick. During that stay, she developed a condition called atrial fibrillation. Atrial fibrillation is an irregular beat of the heart characterized by the loss of synchrony or loss of regular contraction of the top part of the heart, or the atrial chambers. This is important because it reduces how well the heart functions as a pump, but it can also cause symptoms and, of its own, can carry with it some risks. One of those risks is the formation of clots within the heart because of the abnormal pumping.
Well, to cut a long story short and to keep this as an introduction, when my gran was sent out of the hospital as a near-blind, 80-plus-year-old lady with bad rheumatoid arthritis, cardiac failure, diabetes, and wheelchair-bound, she'd been commenced on a medication called warfarin because of the atrial fibrillation. Now, warfarin is a blood thinner and works very well to reduce the risk of stroke. The problem, though, was that my gran was on multiple tablets already. She couldn't really see what she was doing. She had a lot of trouble having regular blood tests, which are what were required for warfarin, and really importantly, her heart was not working properly. Because her heart wasn't working properly, blood accumulated in the organs. One of the important organs that it accumulated in was the liver. The liver is where warfarin is metabolized.
I saw this as all a little bit of a difficult thing to sort out, and to be honest, the risk of stroke, as high as it was, being addressed by warfarin, seemed to present a situation that was going to lead to complications of the therapy that probably outweighed the benefit, at least for my grandmother. I picked up the phone and spoke with the medical team who had made that decision, and quite appropriately, they had commenced a blood-thinning agent which was in keeping with all the guidelines in regard to atrial fibrillation. But all the guidelines didn't really specifically talk about my grandmother. They didn't talk about people who were visually impaired, who were diabetic, who had rheumatoid arthritis, who had cardiac failure, and problems with their liver function, and therefore an inability to potentially clear the drug and manage that drug properly.
Anyway, after a fair bit of discussion, we thought on balance, my gran's life was least complicated by using aspirin instead of warfarin for her in the longer term. Not the perfect management, not the guideline recommendation, but for her, probably, and I feel almost certainly, the best and most sensible compromise. She lived at home for another couple of years and did, in fact, die about three or four years later from a stroke. These things happen, and that is nature's way.
The thing that I really want to share with you, though, is that atrial fibrillation is a common condition. But the way we manage it is almost never common because we're all individuals. Everybody needs a special understanding of their particular needs and their particular situation, and a discussion involving the patient, possibly the family, but certainly the patient and the doctor, looking at the pros and cons of each intervention.
Atrial fibrillation is common. We know it affects over 30 million people in the world. Our statistics would suggest that for adults over 20 years of age, it affects 3% of the population. And for adults over 80 years of age, over 10% of the population. So if you have atrial fibrillation or you know someone who has atrial fibrillation, you're not alone. It is a common condition, and it is something that warrants good information and good education for the patient to be engaged in their own best management.
I hope that in future discussions on the topic of atrial fibrillation, I'm able to explain to you what the condition is, how we diagnose it, how we manage it, how that impacts on you, what are some of the drugs that are involved, and what are some of the other approaches we can use. I hope to cover atrial fibrillation in a way that allows you to understand the best way to look after that condition in your particular situation. I look forward to sharing more with you, and I hope you've enjoyed today's introduction. Thank you.
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