Source: European Journal of Arrhythmia & Electrophysiology. 2019;5(2):77–81
Authors: Kamal Kishor , Devendra Bisht , Sanjay Kalra

Abstract
Atrial fibrillation (AF) is one of the major causes of stroke, heart failure, sudden death and cardiovascular morbidity in the world. Management of AF, its risk factors and complications demands huge cost. The frequent hospitalisations, haemodynamic abnormalities, and thromboembolic events related to AF put a huge emotional and monetary burden on patients, so preventive strategies will be a cost-effective means of reducing this burden. Primordial prevention (i.e., intervention prior to onset of disease risk factors) should be implemented by the government, along with the food industry, to educate the public regarding the importance of a healthy diet and adherence to it. Primary prevention should focus on halting the onset of AF in targeted populations who carry risk factors for development of AF. The strategy at the secondary-prevention level includes optimal control of rate or rhythm either by anti-arrhythmic drugs or catheter ablation. Every effort should be made to reduce the incidence of ischaemic stroke by using optimal oral anticoagulation, devices or surgical closure of left atrial appendage. Tertiary level prevention should focus on the management of complications incurred as a result of AF, such as ischaemic stroke, heart failure or asymptomatic left ventricular dysfunction. Since management of AF demands a huge economic burden and the line between thrombotic complications and bleeding complications is a thin one; over-diagnosis and overtreatment of AF should be avoided. The ultimate aim of quinary prevention is to sensitise the physician to follow evidence-based medicine and to get rid of populated myth. This current review summarises a stepwise preventive strategy for AF from the primordial level to the quinary level.

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