Atrial fibrillation (AF) is an abnormal heart rhythm with rapid and irregular beating. It is estimated to increase the risk of stroke 3 to 5-fold and to be associated with around a quarter of all ischaemic strokes. Additionally, AF is associated with more severe strokes leading to higher mortality and disability.
With support from the BMS-Pfizer Alliance, The Economist Intelligence Unit (EIU), London, UK published a new sub-analysis that assessed how 11 EU countries (Belgium, France, Germany, Italy, the Netherlands, Norway, Russia, Spain, Sweden, Turkey and the United Kingdom) compare against European Society of Cardiology’s recommendations for stroke prevention and #AFib detection. This sub-analysis was published in the “Risk Management and Healthcare Policy” journal.
AF is often asymptomatic and screening is not routinely undertaken in Europe. Accurate information on its prevalence in the general population is therefore not widely available. Some European countries have undertaken screening studies to estimate the proportion of the population affected. They reported rates in the general population ranging from 1.3% (UK, Italy) to 3.9% (Greece), with rates being highly dependent on age. Less data is available from Central and Eastern European countries.
Due to Europe’s ageing population and AF’s strong association with age (0.7% in those aged 55-59 vs. 17.8% in those aged ≥85 years), the prevalence of AF is expected to rise. Using data from the community based Rotterdam Study and population projections from Eurostat, it was estimated that the number of adults over 55 with AF will more than double between 2010 and 2060 from 8.8 million to 17.9 million. An Icelandic study projected the prevalence of AF to rise from 1.9% in 2008 to 3.5% in 2050. (Source: Burden of Stroke Report, 2017)
As stated in the Abstract of this sub-study, all 11 participating countries were found to have policies in place to manage general behavioral risk factors of noncommunicable diseases (NCD), but it was found that more needs to be done to address cardiovascular disease – specifically, stroke risk factors. Although ten of the countries in this study endorse the ESC cardiovascular clinical guidelines, implementation is lacking. Eight out of the 11 countries received the lowest score in regard to raising awareness around stroke, and 7 countries were found not to have a stroke registry. Among physicians surveyed in primary care it was reported that less than 30% of patients over 40 years old were screened for blood pressure, whereas even fewer were screened for atrial fibrillation; in 10 out of the 11 countries, less than 20% of patients over 65 years old were screened for atrial fibrillation.
The findings revealed opportunities for improvement in the primary prevention of stroke which should not be ignored, having in mind that the prevalence of AF is expected to rise significantly over the next few decades.