AF & Stroke - Q2 2020

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AF & Stroke Full campaign on www.healthawareness.co.uk

Trudie Lobban MBE CEO & Founder, Arrhythmia Alliance “Guard against atrial fibrillation by thinking: ‘Detect, Protect, Correct’.”

Professor Martin R Cowie Professor of Cardiology at Imperial College London “Technology does indeed appear to be our friend” Dr Sonya Babu-Narayan Associate Medical Director, British Heart Foundation “The risk of stroke for someone who has AF is five times higher than that of the general population”

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IN THIS ISSUE

04

Be alert to the symptoms of atrial fibrillation

“The NHS Long Term Plan has never been more crucial in providing people with the care they need” Trudie Lobban CEO and Founder, Arrhythmia Alliance

06

It’s important to think: ‘Detect, Protect, Correct’ when it comes to atrial fibrillation, says Trudie Lobban MBE, Founder of the Arrhythmia Alliance.

Doing so could save your life.

“The smartphone has proven to be a boon for the detection of AF” Professor Martin R Cowie Professor of Cardiology, Imperial College London

06 “Hundreds of thousands of people are living with a potential ticking time bomb in their hearts”

INTERVIEW WITH

Trudie Lobban MBE, CEO & Founder, Arrhythmia Alliance

Written by: Tony Greenway

Dr Sonya Babu-Narayan Associate Medical Director, British Heart Foundation

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M

ost heart palpitations are innocent. We all get them from time to time, such as when we’re stressed or anxious. However, atrial fibrillation (AF) — the most common arrhythmia, or heart rhythm disorder — is different.

It means that your heart may not be pumping as well as it should, which can cause blood clots to form. And that can be serious.

The majority of those with AF are 65 and over, although it’s a condition that can occur at any age.

Some people have no symptoms, while others may experience breathlessness or feel as though their heart is beating out of their chest. It can make patients feel very anxious and lethargic.

Worryingly, if you have AF, you are five times more likely to have an AFrelated stroke, the most devastating and debilitating type of stroke, which can, in many cases, be fatal.

Therefore, it’s so important to guard against atrial fibrillation by thinking: ‘Detect, Protect, Correct’.

Why you should know the rhythm of your heart First of all, ‘Detect’ AF with a mobile ECG monitor or a simple pulse check.

Everyone should know the rhythm of their heart through the rhythm of their pulse – and, if this is irregular, see a GP. Sometimes irregular rhythm may be the only symptom of AF. If AF is diagnosed, doctors will ‘Protect’ against AF-related stroke with anticoagulation therapy.

Anticoagulation is not a ‘treatment’ for AF – it does not take away symptoms or the cause of AF. It does, however, help reduce blood clots forming due to the irregular heart rhythm and therefore greatly reduces the risk of AF-related stroke.

It should also be stressed that NICE no longer recommend aspirin to protect against AF-related stroke.

Finally, healthcare professionals will ‘Correct’ the irregular rhythm by offering an appropriate drug or surgical treatment in order to safeguard patients, remove their symptoms and help them lead as active a life as possible.

How COVID-19 is changing life for AF patients Currently, COVID-19 is changing lives in many ways, and that includes how AF patients access medical help or advice, and even the type of anticoagulation therapy they are given.

For example, patients who are prescribed warfarin – a long-established anticoagulant – will need monitoring with regular blood tests. However, to cut down on hospital visits, many doctors are moving patients off warfarin and onto non-novel oral anticoagulants (NOACs), which, studies show, are as good as, or in some cases slightly better than, warfarin. And, crucially, these don’t require regular blood tests.

Obviously, your healthcare professional will prescribe the anticoagulant that best suits your needs, but, going forward, I believe many more AF patients will be prescribed NOACs. I also think there’s going to be a huge uptake in telemedicine. After all, if doctors can carry out patient consultations by video call or phone call, it will cut down the number of faceto-face appointments and reduce the risk of hospital or GP surgery infections.

If you are concerned that your heart rhythm is irregular, the plea is: don’t ignore it. Help is available, and you should seek this as soon as possible to avoid serious complications.

More info:

Contact the Arrhythmia Alliance or its sister charities; Arrhythmia Alliance (A-A), STARS (Syncope Trust And Reflex anoxic Seizures), and Atrial Fibrillation (AF-Assoc) for information, support and education on all arrhythmias including syncope and atrial fibrillation.

Tel: 01789 867 501 / 502/ 503 Email: info@heartrhythmalliance. org / infor@stars.org.uk / info@afa.org.uk URL: heartrhythmalliance.org

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Helping prepare the NHS for the challenges of the next decade The NHS Long Term Plan identifies key goals to help prepare the NHS and health sector for the challenges of the future.

WRITTEN BY:

Trudie Lobban CEO and Founder of Arrhythmia Alliance

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he NHS Long Term Plan was implemented in 2019 to make the NHS fit for the future with key goals set out for the next 10 years. The cardiovascular section is built up of three key components known as ‘ABC’.

The first is atrial fibrillation (AF), which is the most common form of arrhythmia and cause of AF-related stroke. The second is blood pressure in which we see a close link with those with high blood pressure being at an increased risk of developing AF. Finally, C, is cholesterol; poor diet and obesity also link to this area.

The impact of COVID-19 In light of the global COVID-19 pandemic, the NHS Long Term plan has never been more crucial in providing people with the care they need. When it comes to hospital admissions, we have seen a 60% drop in the number of people with heart attack symptoms and 40% decline in those with stroke symptoms visiting A&E than we would at this time normally. This is leading to a significant increase in unnecessary deaths, which could be prevented.

For many people, the current pandemic is an extremely anxious

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time, especially those with pre-existing health conditions. AF is no exception.

While suffering with the condition, you are at no greater risk of contracting the virus, however, it is more likely to have serious complications, which will impact survival rates. It is crucial you remain taking your anti-coagulant medication as normal and please seek advice from your healthcare professional where needed.

'Detect, Protect, Correct, Perfect' When the Long Term Plan was launched it was widely welcomed. Following the global pandemic, it has become increasingly more so as it highlights the importance of supporting those at high risk and in need of further support.

We – collectively – need to efficiently 'Detect' those who are at risk and/or undiagnosed as having AF; ‘protect’ against AF-related stroke with the appropriate therapy; ‘Correct’ the irregular rhythm with the appropriate treatment and, finally, ‘Perfect’ the patient care pathway. This is crucial to help lessen the risks and help people to get the care they need efficiently.

We all have a role to play Alongside other stakeholders, it is

In light of the global COVID-19 pandemic, the NHS Long Term Plan has never been more crucial in providing people with the care they need. important, as individuals, we all take control of our own health to help support and enable the NHS Long Term Plan to succeed. We can do this through increasing our exercise, looking after our weight and blood pressure and eating healthier diets to help prevent these conditions.

Now, more than ever, you should know your pulse to understand your heart rhythm and recognise early symptoms of irregular rhythms of the heart. This not only potentially leads to the prevention of arrhythmias (irregular heart rhythm disorders) but also AF-related strokes.

In the same way we did when the pandemic hit, we need to come together to ensure we are a healthier, fitter and more active nation. This will help support the NHS so they are better able to help us in our hour of need.

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This article is sponsored by Daiichi Sankyo UK Daiichi Sankyo UK Ltd have commissioned this page and have had no input in the other editorial within the publication.

© H EN A DZ I P EC H A N

Cardiovascular events continue to be one of the most significant causes of poor health, with consequent strain on NHS resources.3

Better detection and protection for a more sustainable health service While, for now, we’re correctly urged to stay apart, ensuring the long-term sustainability of our NHS requires a collective, collaborative approach.

A

s we mark Heart Rhythm Week, delivering the ambitions of the NHS Long Term Plan (LTP) has never been more important.

While the world adjusts to managing the COVID-19 pandemic, a question that we have all been reflecting on is: ‘What comes next?’

At a time of unprecedented pressure on capacity, the NHS has proven its resilience to provide care for those in need.

As we look to the future, one thing that has become clear is that health is everybody’s business. Partnership and collaborative solutions are essential to delivering effective preventative care.

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At the heart of the situation The effects of the current crisis have been particularly acute for people with cardiovascular health conditions. Data from hospitals across England show that the number of people admitted to hospital with a suspected heart attack has halved since the beginning of March.1 The experience of early-affected countries, such as Italy, suggests that the majority of coronavirus victims had underlying illnesses – the most common were cardiovascular conditions.2

Cardiovascular events continue to be one of the most significant causes of poor health, with consequent strain on NHS resources.3 One such cardiovascular event is stroke, which remains the fourth biggest killer in the UK.4 One of the major risk factors, atrial fibrillation (AF) – a condition where the heart beats irregularly and rapidly5 – continues to be under-detected and, subsequently, under-treated.

Around 1.2m people are diagnosed with AF annually in the UK but, worryingly, a further 500,000 people are estimated to be living with the condition unknowingly.6 The NHS LTP’s ambition to prevent 150,000 cardiovascular disease events this decade7 is bold but achievable if all parties collaborate to support the health service in the delivery of this ambition.

An essential action is to create programmes aligned with the Academic Health Science Network’s (AHSN) 'Detect, Protect, Perfect' pathway.8 By improving diagnosis of the condition, we can ensure that patients receive appropriate treatment and optimise management for an individual’s heart arrhythmia, both now and in the future.

WRITTEN BY:

Manuel Reiberg Managing Director, Daiichi Sankyo UK

Re-setting the standard of industry partnerships As Managing Director of Daiichi Sankyo UK, a pharmaceutical company that is a committed partner to the NHS, it is our organisational mission to support the NHS to achieve its longerterm cardiovascular health outcome objectives.

After all, we are all potential patients, and it is essential that we create a sustainable future for our health service, where the prevention of disease is at the heart of it.

The LTP suggests that digital technology, as well as closer collaboration with NHS staff, employers and the voluntary and public sectors will drive improvement in patient awareness, and therefore, the management of an individual’s ‘ABC’ (AF, blood pressure and cholesterol).

We will be playing our part in supporting this improvement by bringing together representatives from across the healthcare system to collaboratively embed these solutions into our programmes.

Moving care closer to home COVID-19 has demonstrated that the secondary care system needs better support, even as the LTP enables care to move to a localised, community-setting through Primary Care Networks (PCNs) and Integrated Care Systems (ICS).

Our local partnership with the University College London Partners AHSN to improve the primary care initiation of anticoagulation in London9 is one such example of the potential of how innovative care models can support secondary care services and improve the care of AF patients.

Through the initiative, it is hoped that between 350 to 450 lives will be saved over a five-year period.10 Our health service is an incredible force that delivers improved health outcomes for the population.

Partnerships now, more than ever, are the vehicle to drive that force.

The future is calling for a new approach to partnerships, to support our healthcare system in its objectives and improve outcomes for patients with AF.

Daiichi Sankyo UK Ltd have commissioned this page and have had no input in the other editorial within the publication.

May 2020 DSC/20/0068 Julia Bakker. British Heart Foundation. Lives at risk due to 50% drop in heart attack A&E attendances. 9 April 2020. Accessed at https://www.bhf.org.uk/what-we-do/news-from-the-bhf/news-archive/2020/april/drop-inheart-attack-patients-amidst-coronavirus-outbreak 2 Angela Giuffrida. The Guardian. 'This is like a war': view from Italy's coronavirus frontline. 17 March 2020. Accessed at https://www.theguardian.com/world/2020/mar/17/this-is-like-a-war-view-from-italys-coronavirus-frontline 3 Public Health England. Ambitions set to address major causes of cardiovascular disease. https://www.gov.uk/ government/news/ambitions-set-to-address-major-causes-of-cardiovascular-disease Accessed April 2020 4 Stroke Association. State of the nation. Stroke statistics. February 2018. Accessed at https://www.stroke.org.uk/ sites/default/files/state_of_the_nation_2018.pdf. Accessed April 2020 5 Stroke Association. State of the nation. Stroke statistics. February 2018. Accessed at https://www.stroke.org.uk/ sites/default/files/state_of_the_nation_2018.pdf. Accessed April 2020 6 Stroke Association. State of the nation. Stroke statistics. February 2018. Accessed at https://www.stroke.org.uk/ sites/default/files/state_of_the_nation_2018.pdf. Accessed April 2020 7 NHS England. The NHS Long Term Plan. Accessed at https://www.longtermplan.nhs.uk/publication/nhs-longterm-plan/. Accessed April 2020 8 Academic Health Science Network. Atrial fibrillation. Detect, protect and perfect. Accessed at https://www. ahsnnetwork.com/about-academic-health-science-networks/national-programmes-priorities/atrial-fibrillation.

Accessed April 2020 9 UCL Partners. Increasing detection and treatment for atrial fibrillation. Available at https://uclpartners.com/work/ increasing-detection-and-treatment-for-atrial-fibrillation/ Accessed April 2020 10 Daiichi Sankyo UK. Joint working. Accessed at:https://www.daiichi-sankyo.co.uk/fileadmin/daiichi-sankyo-contents/DS_UK/Downloads/About_Us/DSC_19_0025_Joint_working_Executive_Summary_-_Oct_2019.pdf 1

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How a smartphone may help prevent strokes Every year, the phone in our pockets can do more: did you know it might also help reduce your chance of a stroke?

WRITTEN BY:

Professor Martin R Cowie Professor of Cadiology, Imperial College London (Royal Brompton Hospital) Trustee, Atrial Fibrillation Association

A

trial fibrillation (AF) is a heart rhythm problem that sadly can go unnoticed until you suffer a stroke.

A stroke is caused by a small clot forming inside the heart and then shooting off to damage your brain.

Doctors have been trying for many years to pick up this irregular heart rhythm as early as possible as, once AF is detected, it may be reversible.

For decades the only way to record a tracing of your heartbeat – an electro-cardiogram (ECG) – was to go to your GP or a hospital to be wired up to a machine.

But this lack of access could result in unreliable data. Sometimes, AF can be intermittent. During your ECG appointment your heart could (temporarily) go back to normal rhythm and false reassurance might then be given.

Don't ignore AF warning signs

© K ATA R Z Y N A B I A L AS I E W I CZ

Hundreds of thousands of people across the UK are living with a silent, undetected threat in their hearts.

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Smart phones and watches help identify AF Last year, the Apple Heart study was published, where more than 400,000 people who had an Apple Watch volunteered to see if the irregular pulse alarm could help identify those with AF. The results were promising: (although many of the volunteers were young and therefore not very likely to have AF) many potential cases were identified, and most were confirmed on further testing.

More recent versions of the Apple Watch now can record a simple ECG for the wearer to email to their doctor. The watch is not sold as a diagnostic device, but this may well be a useful added benefit.

The smartphone has also proven to be a boon for the detection of AF. The Kardia/AliveCor device is a small metal plate that fits on the back of a smartphone and records a simple ECG. Studies in the UK and elsewhere show impressive ability to identify people who did not know they had AF. A large GP-based study in Cambridge is currently examining whether this approach might reduce strokes if a similar technology is ‘prescribed’ for patients for a few weeks.

Even your smartphone camera and light may be able to help: an app, (Fibricheck) has been developed to detect AF by examining the pulse in your fingertip.

If ongoing studies work out, then this might be an even simpler way to ensure everyone can quickly check their pulse from time to time.

Dr Sonya Babu-Narayan Associate Medical Director, British Heart Foundation

Healthcare professionals and patients embrace new tech Doctors, along with the patient charity, Atrial Fibrillation Association and Arrhythmia Alliance, have welcomed any attempt to improve AF detection.

Technology does indeed appear to be our friend. But, it is important to remember that even where technology is not available, a simple ‘pulse check’ with someone learning to feel their pulse (and that of their family and friends) can flag up issues too.

More info: To help patients find answers and have easy access to information, we’ve developed a suite of support services, such as our Heart Helpline and comprehensive online coronavirus hub.

Professor Martin R Cowie is Professor of Cardiology at Imperial College London (Royal Brompton Hospital) and is a Trustee of the Atrial Fibrillation Association. He has no financial interest in any of the technologies mentioned in this article.

bhf.org.uk/coronavirus bhf.org.uk/ informationsupport/ our-heart-helpline bhf.org.uk/ informationsupport/ conditions/atrialfibrillation © M I C R O G EN

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hat undetected threat is a heart rhythm disorder known as atrial fibrillation (AF). AF is not life-threatening, but it can cause adverse symptoms and lead to a poorer quality of life.

Turbulent and stagnant blood flow within the hearts of people with AF increases the risk of a blood clot forming, which can lead to a devastating stroke if it travels up to the brain.

The risk of stroke for someone who has AF is five times higher than that of the general population, and AF may only be diagnosed after a stroke has already happened.

AF is diagnosed by an electrocardiogram (ECG), which takes a record of the heart’s electrical activity. An ECG might be done over a longer period of time to investigate palpitations if AF is intermittent.

200,000 people could be living with undiagnosed AF Once AF is diagnosed, an individual risk assessment for stroke can be made to assess whether it's appropriate to prescribe blood-thinning medications to reduce the chance of clots forming.

Many people with AF are diagnosed because they experience a fast, irregular heartbeat or have other symptoms.

However, the BHF estimate that more than 200,000 people are living with undiagnosed AF in the UK. This is worrying as some of these people may go on to suffer a stroke that could claim their life, leave them with physical disability or contribute to vascular dementia, which could have been avoided.

Wearable tech may help prevent AF BHF researchers are working hard to find new and better ways to understand, prevent and diagnose AF. Studies are ongoing to see how the technologies available today - wearables, smartphones and smartwatches - could help in future.

This tech could be used to detect

abnormal heart rhythms. The data can be combined with AI and routinely collected healthcare data, to improve diagnosis.

Palpitations are a sensation of feeling your heartbeat. In most cases these are harmless.

However, if your palpitations last a long time, don't improve or get worse, you should seek medical advice – despite the current pandemic.

This also applies if you have a history of heart problems and experience palpitations for the first time.

If you experience sudden dizziness, shortness of breath, fainting, chest pain or tightness, then it's vital you seek urgent medical attention despite concerns over COVID-19.

COVID-19 innovations may help in detecting AF earlier As we move towards restoration of regular NHS services and a new normal, the evidence-based treatment of highrisk conditions, such as AF, needs to be made a priority again.

Innovations and research brought about by the pandemic may lead to transformative ways to efficiently achieve NHS England's Long Term Plan to detect AF early and treat it appropriately.

We cannot forget that hundreds of thousands of people are living with a potential ticking time bomb in their hearts. We must look out for them.

We must support more research to address the questions that remain, including the potential burden of detecting AF incidentally with new smart technologies.

Meanwhile, people with symptoms should not hesitate to seek help. We who work in the NHS want to help all our patients get the treatment they need – those with COVID-19 and those without.

The BHF's priority also still stands – we will continue to support the 7.4 million people in the UK living with heart and circulatory diseases.

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Recognising Heart Attacks, Strokes and Heart Failure during the Coronavirus pandemic and beyond.

- Professor Ahmet Fuat GP and GP Specialist in cardiology We are hearing that fewer people are being seen in hospital with heart attacks, strokes and heart failure in recent weeks, which suggests that people are not seeking help when they should do. If you have any of the symptoms described below, you should call 999.

Stroke strikes every five minutes in the UK. It can happen to anyone, of any age, at any time. It is commoner if you have poorly controlled high blood pressure, diabetes or if you have an irregular heart rhythm disorder called Atrial Fibrillation. It is vital to know how to spot the warning signs of a stroke in yourself or someone else. Using the FAST test is the best way to do this.

Signs of stroke - FAST test

• • • • •

Sudden weakness or numbness on one side of the body, including legs, hands or feet.

Difficulty finding words or speaking in clear sentences.

Sudden blurred vision or loss of sight in one or both eyes.

Sudden memory loss or confusion, and dizziness or a sudden fall.

A sudden, severe headache.

If you spot any of these signs of a stroke, do not wait. Call 999 straight away.

Ambulance paramedics are trained in stroke, and will take the person to the best hospital for specialist treatment.

Face: Facial weakness. Can the person smile? Has their face fallen on one side?

Arms: Arm weakness. Can the person raise both arms and keep them there?

Speech problems: Can the person speak clearly and understand what you say? Is their speech slurred?

Time: If you see any of these three signs, it’s time to call 999.

There is no way of knowing if symptoms will pass or get better when they first start, so you need to seek immediate medical help. A stroke is a medical emergency. Always dial 999. The quicker the person arrives at a specialist stroke unit, the quicker they will receive appropriate treatment The FAST test helps to spot the three most common symptoms of stroke. But there are other signs that you should always take seriously. These include:

Recognising Heart Attacks, Strokes and Heart Failure during the Coronavirus pandemic and beyond.

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DETECT PROTECT CORRECT

Currently, COVID-19 is changing lives in many ways, and that includes how AF patients access medical help or advice, and even the type of anticoagulation therapy they are given.