Fighting the silent killer

How we can tackle millennium epidemic

By Alenka Brzulja

Vice President of Cardiovascular & Specialty Solutions EMEA, Johnson & Johnson Medical Devices Companies.

Over the last 20 years at Biosense Webster, we have been helping patients and healthcare professionals deliver early detection, diagnosis and the right treatment options for Atrial Fibrillation (AF) patients across the world.

AF is a cardiac condition characterized by an irregular and often fast heart rhythm that results in an uncoordinated contraction of the top two chambers of the heart.This arrhythmia increases the risk of other potentially fatal conditions, leading to five times the risk of heart failure, a 2.4 times increase in the risk of stroke, and a two fold increase in the risk of cardiovascular mortality.2

Despite the devastating outcomes for undiagnosed and untreated AF, 45% of patients mistakenly believe it is not life-threatening.3

By 2030, the number of people with AF is projected to increase by up to 70% in Europe.4 To look at it another way: over 886,000 people are diagnosed each year and today it affects 11 million Europeans. These 886,000 new cases each year are projected to translate into 280,000-340,000 additional ischaemic strokes, 3.5-4 million hospitalisations for AF and 100-120 million outpatient visits. AF as a disease costs healthcare systems in Europe between €660 - €3286 million annually.5

It is clear that the economic and social impact of AF is potentially shattering for healthcare systems and people across Europe. It is a condition that needs more education and awareness initiatives to healthcare professionals (HCPs), patients and policy makers.

The publication of our Burden of Disease Report (2018), highlighted the burden of AF as one of Europe’s most significant health issues.4-6 In 2019 we partnered with Arrhythmia Alliance on the ‘Get Smart About AFIB’ public health campaign and launched the Atrial Fibrillation Management report which examines the available treatment options for AF across Europe and their long-term impact on clinical, patient and economic outcomes. These activities are aimed at helping to bridge the awareness gap among the cardiology community on catheter ablation and its effectiveness in treating patients.

Treatment of AF focuses on managing the irregular heart rhythm, improving symptoms and reducing complications — with the overarching aim of improving life expectancy and quality of life.7 The current treatment options available for the long-term management of AF patients in Europe are: antiarrhythmic drugs (AADs) and catheter ablation.

Cardiac catheter ablation is an interventional technique that neutralizes parts of the abnormal electrical pathway that causes arrhythmia. This treatment technique uses a variety of imaging and monitoring systems that navigate flexible wires, called catheters, into the heart through an artery or vein.

The Atrial Fibrillation Management Report, which reviewed independent studies of current treatments, highlighted that just half of patients (52%) are well-managed by AADs8 yet, despite this, only 4% of eligible patients receive catheter ablation9 — a treatment that’s considered almost 10 times more effective in delaying AF progression than AADs.10

Catheter ablation is highly effective: 94% of patients are free from arrhythmia recurrence at one year, and 48% are free from arrhythmia after four years.11.12

Up to 37% of patients’ quality of life improves with catheter ablation compared to 18% when treated with ADDs.13,14 There is up to 46% lower

incidence of death, stroke, cardiac arrest and cardiovascular hospitalization over seven years, when compared to patients treated with AADs.12 An expert consensus statement on catheter and surgical ablation of AF recommends an integrated management strategy to reduce mortality, tailor management to patient preferences, and reduce hospitalizations.8,15

Working within guidelines, an integrated approach is needed to manage the treatment of AF that involves the patient and multidisciplinary teams of HCPs including cardiologists and electrophysiologists, to improve access to care and patient compliance by placing patients in a central role in the decision making.

Education and screening programs aimed at increasing awareness and diagnosis of AF are critical to reducing the risk of stroke and death in patients with diagnosed and undiagnosed AF. Most patients’ first point of contact if they feel unwell, or if a member of their family suspected something was not right was their primary care physician. Educating HCPs on how to detect, diagnose and inform patients and their caregivers about the best treatment options available is vital if we are to harness the positive results brought about by catheter ablation as a treatment option.

As we begin this new decade, let us rethink how we manage and communicate the treatment options for AF. As more pressure is placed on healthcare systems to utilize resources more effectively, invest in appropriateness (the right treatment for the right patient) and the communities they live in may be a better solution.

I believe we are duty bound to ensure that all HCPs involved in the management and treatment of AF throughout Europe have a clear picture of all the options available — ensuring that no patient misses out on a potentially life-saving procedure.



 February 2020