Calls for over-65s to be screened for condition that causes deadliest strokes

Heart pacemakers are used to treat arrhythmias. Photo: Peter Dazeley Atrial fibrillation is an irregular heartbeat and it can cause ischaemic stroke.

The iECG: an iPhone app developed by the University of Sydney provides a cheap and accurate method of detecting heart rhythm problems.

Some people with atrial fibrillation use a pacemaker. Photo: Guy Magowan

A patient is fitted with a pacemaker. Photo: Rohan Thomson

An international consortium of cardiologists is calling for regular screening of all people aged over 65 for irregular heart rhythms, which are linked to one in three strokes in Australia.

A chaotic heartbeat, known as atrial fibrillation, can be effectively treated with oral anticoagulants such as Warfarin, but many patients are unaware that they have the condition or fail to take the appropriate medicine.

Left untreated, the seemingly benign condition can lead to an ischaemic stroke that is usually more catastrophic and frequently fatal than strokes from other causes.

Heart Research Institute cardiologist Ben Freedman argued in The Lancet on Friday for the routine testing of people aged over 65, ahead of a consensus statement that will be nutted out by 100 global heart experts at the ESC Congress in Rome next week.

The article called for doctors to adopt a default position of prescribing anticoagulants to all patients with atrial fibrillation unless they were identified as “truly low risk”.

There are 50,000 strokes a year in Australia and the authors estimate that by screening 75 per cent of people over 65 and getting 80 per cent of people with atrial fibrillation onto medication, 250 strokes would be prevented annually.

“We recognise that this is a really important way to prevent stroke,” Professor Freedman said.

“Atrial fibrillation is something many people have not heard of, and yet it’s very common. One-third of strokes are caused by atrial fibrillation.”

One study indicated that in more than a quarter of strokes related to atrial fibrillation, the patient did not previously know they had the condition.

But Professor Freedman said that even among patients who knew they had atrial fibrillation, many did not take their medication or discontinued it because they were concerned about the possible side-effects of the anticoagulants, which include internal bleeding.

“People are a bit scared of taking anticoagulants and doctors are a bit scared of prescribing them because they don’t like causing bleeding,” Dr Freedman said.

“But the benefits outweigh the risk.”

The consensus statement will be drawn up by the stroke prevention group AF-SCREEN International Collaboration, which was co-founded by Dr Freedman and has 100 members from 30 different countries.

Dr Freedman declared conflicts of interest including research grants from several pharmaceutical companies that make anticoagulants.

Mary MacKillop Institute for Heart Research director Simon Stewart, who does not have any affiliations with pharmaceutical companies, said he supported calls to screen people over 65 because atrial fibrillation was common, easy to detect and potentially deadly.

The condition affects one in 10 people over 65 and one in five people over 80.

But it would encourage over-servicing by those who had a commercial interest in detecting and treating the condition, he said.

“I’m not putting it down, but you widen the spectrum of a diagnosis and you widen the treatment,” Professor Stewart said.

“There are new oral anticoagulants on the market compared to the ones that are cheap.

“I actually regard the cardiologists and the drug companies as bad as each other for over-servicing and there’s probably going to be a shark frenzy of electrophysiologists selling devices.”

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