Personalized Care Focused on Lifestyle Factors May Lower Risk of Atrial Fibrillation
Atrial Fibrillation: A Growing Heart Condition with Multifaceted Risk Factors
Atrial fibrillation (AF), the most common arrhythmia or irregular heartbeat, affects over 33 million people worldwide. This heart condition arises from an irregular beating of the left upper heart chamber or atrium, leading to a potential risk of stroke.
Beyond known cardiovascular health factors, such as physical activity, diabetes, obesity, and smoking, the presence of chronic conditions, including cardiovascular, respiratory, metabolic, and mental health conditions, significantly heightens the risk of AF.
A recent review, published in Heart Rhythm, explores lifestyle factors, comorbid conditions, and socioeconomic factors that potentially influence the risk of AF. This analysis underscores the need for a multidisciplinary and individualized approach to managing AF and reducing the risk of mortality and other health complications.
Dr. Stephen Tang, a board-certified cardiac electrophysiologist, emphasizes that the comprehensive management of AF extends beyond oral anticoagulation for stroke prevention or rate or rhythm control with medication or ablation. He explains that this complex disease is driven by numerous risk factors and comorbidities.
"If these are not controlled, atrial fibrillation will continue to occur despite ablation," Dr. Tang warns. Identifying and optimizing these risk factors, he adds, is essential for the long-term management and control of AF.
Risk Factors and Treatments for Atrial Fibrillation
Known as "AFib," atrial fibrillation often results from an abnormal heart rhythm caused by irregular beating in the left upper heart chamber. This irregular heart rhythm can result in the formation of a blood clot in the atrium, which can dislodge and travel to the brain, causing a stroke.
While genetic factors, sex, and increased age are non-modifiable risk factors for AF, other risk factors include lifestyle factors, comorbid conditions, and socioeconomic factors.
Blood thinners, or anticoagulants, can reduce the risk of blood clot formation and stroke for individuals with AF. These drugs target vitamin K (e.g., warfarin) or block other factors (e.g., nonvitamin K antagonist oral anticoagulants, or NOACs).
Other drugs, such as beta-blockers and calcium channel blockers, help control the heart rate. In cases where lifestyle modifications and medications are ineffective, invasive procedures like catheter ablation may be required to restore a normal heart rhythm.
Lifestyle Factors Influencing AFib Risk
Similar to other cardiovascular conditions, lifestyle factors such as physical activity levels, obesity, smoking, and alcohol consumption are associated with an increased risk of AFib incidence and symptom severity.
Meeting the recommendation of at least 150 minutes of moderate-to-vigorous training per week reduces the risk of AFib. Regular moderate-to-vigorous training and high-intensity interval training improve morbidity and quality of life in individuals with AFib. Though some research associates physical activity with reduced stroke risk in AFib patients, further evidence is needed to definitively support this claim.
Obesity increases the risk of AFib, recurrence, complications, and death. Weight loss can help reduce these risks. Moderate alcohol consumption and smoking are AFib risk factors; however, the relationship between low levels of alcohol intake and AFib is unclear.
Health Conditions Co-occurring with AFib
Chronic cardiovascular, respiratory, and mental health conditions are not only risk factors for AFib but can also increase complications associated with the condition.
Obstructive sleep apnea, present in 21-74% of AFib patients, increases the risk of AFib recurrence after catheter ablation. The use of a continuous positive airway pressure (CPAP) machine for managing sleep apnea can help reduce the risk of AFib incidence, recurrence, or progression.
Individuals with pre-existing cardiovascular conditions, such as coronary artery disease, hypertension, heart failure, and cardiomyopathies, face an increased risk of AFib. Effective management and treatment of comorbid cardiovascular conditions, like hypertension, help reduce the risk of AFib recurrence or complications such as stroke.
While the use of anticoagulants is necessary for maintaining a regular heart rhythm, they should be used judiciously in patients undergoing minimally invasive surgery for coronary artery disease due to the risk of bleeding.
Chronic respiratory conditions, such as COPD, are linked to a twofold higher risk of AFib. Some medications used for managing COPD, like corticosteroids, do not have adverse effects in individuals with AFib. Short-term exposure to air pollution has also been connected to an increased risk of AFib.
Studies show that psychological factors, such as stress and depression, are associated with an increased risk of AFib. Antidepressants increase the risk of AFib, and the risk decreases with an improvement in depressive symptoms. Though there is a lack of evidence to support cognitive impairment and dementia as risk factors for AFib, dementia is associated with poor outcomes in individuals with this cardiovascular condition.
Impact of Comorbid Conditions and Multiple Medication Use
Individuals with AFib are more likely to have other comorbid conditions. The presence of these concomitant chronic health conditions, along with aging, increases the risk of complications such as stroke and mortality in individuals with AFib.
The use of five or more drugs, known as "polypharmacy," is associated with an increased risk of complications in individuals with AFib. Nonvitamin K antagonist oral anticoagulants are associated with fewer adverse events than warfarin in AFib patients and can be used after taking adequate precautions.
Other Risk Factors for Afib
In addition to lifestyle factors and comorbid conditions, sex, socioeconomic status, and ethnicity/race can influence the risk of AFib.
Studies suggest that South Asian and African individuals are at a lower risk of AFib than the white population, contrary to their higher risk of other cardiovascular conditions. Conversely, white individuals have a higher risk of AFib in the United States.
In terms of biological sex, AFib is more prevalent in men but is associated with a higher risk of complications, including stroke and mortality, in women. The higher risk of complications in women is attributed to differences in biological factors, access to healthcare, and psychological factors, such as stress.
Low socioeconomic status is associated with an increased risk of heart failure, stroke, and mortality in individuals with pre-existing AFib. Lower socioeconomic status may influence access to healthcare, while lower health literacy can influence the patient's participation in treatment decisions.
Need for Individualized Care for Afib
Due to the multifaceted nature of risk factors, a multidisciplinary approach tailored to an individual’s specific needs is essential for effective management and treatment of AFib. Adopting this individualized approach enables healthcare providers to target key triggers and develop effective strategies to manage the disease.
Dr. Nikhil Warrier, a board-certified cardiac electrophysiologist, explains the importance of tailoring AFib management to the patient. "The underlying risk factors that increase the likelihood of poor AF-related outcomes can be different for every patient," he says.
In the words of Dr. Yehoshua Levine, a cardiologist, "Optimal management of AF is very patient-dependent and necessitates careful consideration of multiple clinical, socioeconomic, and demographic factors, which are all important in determining the most appropriate treatment approach."
- Atrial fibrillation (AF) also correlates with chronic conditions like mental health conditions, which can increase the risk of AF further.
- The presence of multifaceted risk factors, such as obesity, depression, and nutrition imbalances, significantly contributes to the occurrence and severity of AFib.
- Proper management of AFib needs to consider financial aspects, as many treatments can incur significant medical-expenses, including personal-finance considerations for managing expenses related to treatments and medications.
- A recent study investigates the impact of socioeconomic factors on the risk of AFib incidence, recurrence, and progression.
- Obesity is a significant risk factor for AFib, but weight loss and fitness-and-exercise can help reduce these risks, emphasizing the role of health-and-wellness in managing AFib.
- Cardiovascular health is closely tied to AFib, and conditions like stroke can result from an irregular heartbeat in individuals with AFib.
- To address the complexity of AFib, science is seeking a predictive algorithm that considers all the factors involved, aiming to develop a more precise prognosis and customized treatment plans.
- The risk of complications associated with AFib increases for patients who have co-occurring chronic diseases like diabetes and respiratory conditions, highlighting the need for a holistic, multidisciplinary approach to managing these patients.
