The old songs are the best !!
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| Oh Doctor I'm in trouble .. |
A few facts :
- More than 1 in 200 people over 50 have it - and 1 in 10 over-80's.
- AF increases your risk of having a stroke 5 fold
- The reason why people who have AF suffer with strokes is because the top chambers or atria of the heart are beating irregularly and clots form in them, in particular in the left atrial appendage (LAA), a small blind ending pouch off the main left atrial chamber. The clots then break away and travel up through the blood vessels to the brain where they interrupt the blood supply to cause a stroke. (This ‘appendix’ of the heart is not necessary for normal heart function and is routinely removed during certain types of heart surgery. With the LAA removed the chances of having a stroke are greatly reduced and patients do not need to take warfarin.)
- AF-related strokes are particularly nasty ones, doing more damage or being more likely to prove fatal than strokes not caused by AF.
- If someone has AF, and another major risk factor for stroke (such as heart failure) they are usually advised to take treatments which thin the blood.
- This has, until know, meant treatment with warfarin - or rat poison to the man in the street.
- Warfarin is not easy to control, many other things can interfere with its action, and it involves regular blood tests to monitor - many patients aren't taking enough of the drug - at least 50% are under treated and so not protected, while over treatment leading to nasty haemorrhages is also fairly common.
- New drugs have just got their licences - they give a much more regular control than warfarin - but at about £2.50 a day they work out at twice the cost of warfarin (which is cheap as chips) + the monitoring costs involved with warfarin (total £1.18). There are hundreds of thousands of people on warfarin, so the NHS will only fund the new drugs for a few.
On the wards in our hospital (which has a specialised Stroke rehab unit) we help lots of people juggle their warfarin dose. But we will have to wait to hear what our Pharmacy Protocol says before we prescribe the new drugs (Rivaroxaban or Dabigatran). Given the endless financial strains/overspends/cutbacks, warfarin may remain the only treatment on the menu for now.
If you don't fancy rat poison, here's a different option - looks like a jellyfish but the Watchman Device is like a tiny fishing net inserted into the major blood to catch clots before they hurtle up to the brain.
Of course, there are many other important aspects of AF that need consideration -
For more on AF, here's a wonderful poster by the manufacturers of dabigatran.
or hook in to The Atrial Fibrillation Association
