Please check my figures on Stroke.

[Guest guest]

I tried this just to see how it comes out. I would appreciate any

thoughts, comments, complete dismantling

Number of strokes in the US in one year 700,000

If we accept 20% of these are amongst people with AF 140,000

Number of people who suffer from AF in any given year 2,000,000

(currently)

140,000 as a percentage of 2,000,000 (roughly) 7%

Sooo....does this mean 7% of AF sufferers are likely to have a stroke?

This does not take into account anything about Coumadin or any other

medication. The figure may well be low BECAUSE people are on Coumadin.

[Guest guest]

That figure seems grossly high. I hope. That would be a 7% risk

annually, which would translate to approximately a 100% risk of stroke,

if you have a-fib for 15 years. Something's wrong here, but I'm not

sure exactly where.

I think your figures are reasonable, but I hope there is a

disconnect somewhere in your equation. I would figure closer to 2.5

million people in the US with a-fib, which would lower the afib

estimated stroke rate a bit. And I'm not sure where you got the 20%

figure, although I do remember reading something to that effect,

somewhere.

I think your calculations should spur a great deal of discussion.

Nice job laying all this out for us! Let's see what happens.

Mike in Minnesota

>

> I tried this just to see how it comes out. I would appreciate any

> thoughts, comments, complete dismantling

>

> Number of strokes in the US in one year 700,000

> If we accept 20% of these are amongst people with AF 140,000

> Number of people who suffer from AF in any given year 2,000,000

> (currently)

>

> 140,000 as a percentage of 2,000,000 (roughly) 7%

>

> Sooo....does this mean 7% of AF sufferers are likely to have a stroke?

> This does not take into account anything about Coumadin or any other

> medication. The figure may well be low BECAUSE people are on Coumadin.

>

[Guest guest]

[1] suppose the annual risk of stroke is 7%.

that means the odds of not having one is 0.93.

in 15 years, the odds of not having one is 0.93 multiplied 15 times.

that is about 0.34

(if 5% then 0.46)

[2] stroke risk jumps up at around age 65.

so the numbers are likely good for people older than 65

[3] if I the 7% figure is applicable to 65 yr old a-fibbers,

the odd of not having a stroke by age 80 is 34%.

younger a-fibbers have much less risk

[Guest guest]

> " Even after adjusting for other cardiovascular risk factors, the incidence

of embolic complications in untreated patients with atrial fibrillation is

threefold to fivefold that for those in normal sinus rhythm, or an absolute risk

of about 5% per year. "

> http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1303541

>

> Jo Anne

>

PUT YOUR CALCULATORS DOWN AND STEP AWAY FROM THE STATISTICS

OK folks, can we all at least concede that the stroke risk is an

individual problem? I've seen the 'fivefold' increase quoted in many

articles on this but it really is pretty meaningless when viewed in

isolation. The same article above also says....

" In patients with atrial fibrillation not associated with any clinical

risk factors (lone atrial fibrillation), age alone appears to

add a modest incremental risk for thromboemboli: 0% in

patients younger than 60 years, 1.6% annually in

patients 60 to 69 years, and 2. 1% annually in those 70 to

79 years of age.65 "

Coming up with a stroke figure for the average AFer tells us very little

when the range varies so much in the AF population. If you are fortunate

to be in the very low risk group (lone AFer under 60 with no other risk

factors) then introducing a risk of intracranial haemorrhage is maybe

not such a good idea. Even if the haemorrhage risk is low it starts to

become significant if your stroke risk is also low. (That's why all the

world is not taking warfarin)

I'm sure the fear of a stroke is looming in all our minds but I think we

should try to spot the difference between fear and risk. I have no doubt

at all that many AFers should be taking warfarin to reduce their stroke

risk. I also have no doubt at all that a lucky minority of AFers should

not be taking warfarin.

The fun starts of course when you try to figure out where one lies in

this risk range. Having a good doctor that you can communicate with is a

really useful starting point.

If you want to play it 'safe' then the best thing you can do is choose

the medication most appropriate to your individual thromboembolic risk.

--

D

[Guest guest]

The problem is when people are diagnosed, it is not readily determined whether a

person is a lone AFer. They gave my husband prescriptions when the only tests

they had done were EKG, blood pressure and pulse. The next day they did an

echocardiogram and the day after that they did blood tests.

My husband's doctor speculated last week that he might have developed atrial

fibrillation because his right atrium was enlarged. This is after my husband

had been under treatment for a month. And I had been thinking that perhaps the

atrial fibrillation caused the enlarged right atrium.

In short, I don't know yet whether my husband is a lone AFer. Also, I don't

know whether someone can be a lone AFer when they have an enlarged atrium.

So, at least, when first diagnosed as having atrial fibrillation, I don't think

they can know for sure if the person is a lone Afer, and that being the case

they cannot be certain that there are no other cardiovascular risk factors. It

seems then that it might be better to prescribe warfarin and perhaps change

later when more is known about the patient.

And I am frustrated that my husband does not really have a diagnosis, just a

name for his symptom of atrial fibrillation. And the drugs don't seem to be

really meant to treat the cause, but just the symptoms. Etc., etc., etc.

Jo Anne

Re: Re: Please check my figures on Stroke.

> " Even after adjusting for other cardiovascular risk factors, the incidence

of embolic complications in untreated patients with atrial fibrillation is

threefold to fivefold that for those in normal sinus rhythm, or an absolute risk

of about 5% per year. "

> http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1303541

>

> Jo Anne

>

PUT YOUR CALCULATORS DOWN AND STEP AWAY FROM THE STATISTICS

OK folks, can we all at least concede that the stroke risk is an

individual problem? I've seen the 'fivefold' increase quoted in many

articles on this but it really is pretty meaningless when viewed in

isolation. The same article above also says....

" In patients with atrial fibrillation not associated with any clinical

risk factors (lone atrial fibrillation), age alone appears to

add a modest incremental risk for thromboemboli: 0% in

patients younger than 60 years, 1.6% annually in

patients 60 to 69 years, and 2. 1% annually in those 70 to

79 years of age.65 "

Coming up with a stroke figure for the average AFer tells us very little

when the range varies so much in the AF population. If you are fortunate

to be in the very low risk group (lone AFer under 60 with no other risk

factors) then introducing a risk of intracranial haemorrhage is maybe

not such a good idea. Even if the haemorrhage risk is low it starts to

become significant if your stroke risk is also low. (That's why all the

world is not taking warfarin)

I'm sure the fear of a stroke is looming in all our minds but I think we

should try to spot the difference between fear and risk. I have no doubt

at all that many AFers should be taking warfarin to reduce their stroke

risk. I also have no doubt at all that a lucky minority of AFers should

not be taking warfarin.

The fun starts of course when you try to figure out where one lies in

this risk range. Having a good doctor that you can communicate with is a

really useful starting point.

If you want to play it 'safe' then the best thing you can do is choose

the medication most appropriate to your individual thromboembolic risk.

--

D

Web Page - http://www.afibsupport.com

List owner: AFIBsupport-owner

For help on how to use the group, including how to drive it via email,

send a blank email to AFIBsupport-help

Nothing in this message should be considered as medical advice, or should be

acted upon without consultation with one's physician.

[Guest guest]

> The problem is when people are diagnosed, it is not readily determined whether

a person is a lone AFer. They gave my husband prescriptions when the only tests

they had done were EKG, blood pressure and pulse. The next day they did an

echocardiogram and the day after that they did blood tests.

>

> My husband's doctor speculated last week that he might have developed atrial

fibrillation because his right atrium was enlarged. This is after my husband

had been under treatment for a month. And I had been thinking that perhaps the

atrial fibrillation caused the enlarged right atrium.

>

> In short, I don't know yet whether my husband is a lone AFer. Also, I don't

know whether someone can be a lone AFer when they have an enlarged atrium.

>

> So, at least, when first diagnosed as having atrial fibrillation, I don't

think they can know for sure if the person is a lone Afer, and that being the

case they cannot be certain that there are no other cardiovascular risk factors.

It seems then that it might be better to prescribe warfarin and perhaps change

later when more is known about the patient.

>

> And I am frustrated that my husband does not really have a diagnosis, just a

name for his symptom of atrial fibrillation. And the drugs don't seem to be

really meant to treat the cause, but just the symptoms. Etc., etc., etc.

>

> Jo Anne

Hi Jo Anne , I totally agree that medicine has to get much better at

diagnosing AF. Maybe one day the doctors will get to the bottom of it an

will start curing us but in the meantime we've got to try make do with

what is essentially palliative care. (though some flavours of AF are

more treatable than others)

Whether we should all be given warfarin straight away before a more

detailed diagnosis might be worth a research grant but I'd prefer a

rapid and accurate diagnosis. It sounds like you are thinking of

warfarin as the 'better safe than sorry' med but for some individuals it

could well be that that aspirin is the 'better safe than sorry' med.

What's required, as you say, is a quick and accurate diagnosis.

Hans Larsen (yes I believe some things I read on that site

recently reported on some research that suggests that only afibbers with

a left atrial volume less than 32mL/m2 should be classified as “loneâ€.

reference is

Osranek, M, et al. Left atrial volume predicts

cardiovascular events in patients originally diagnosed with

lone atrial fibrillation: three-decade follow-up. European

Heart Journal, Vol. 26, 2005, pp. 2556-61

and the abstract can be read here...

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstra\

ct&list_uids=16141257&query_hl=2&itool=pubmed_docsum

--

D

[Guest guest]

> >

>

> PUT YOUR CALCULATORS DOWN AND STEP AWAY FROM THE STATISTICS

>

Lol!

Good sense there .

[Guest guest]

snip: In short, I don't know yet whether my husband is a lone AFer. Also, I

don't know whether someone can be a lone AFer when they have an enlarged atrium.

I'm sensing some frustration here over the diagnosis of " lone " afib. Lone

just means no underlying structural heart problems.. it doesn't mean no afib,

and has little reference to the actual treatment of the problem. It also has

no reference on the frequency of events... it doesn't mean " one " event as the

word might suggest. If you've got lone afib, or have been fibbing for a while

unbeknownst and have some structural changes, the goal is STILL to get you

either back in NSR or good rate control, both of which will save the heart from

future damage. You indicate that your husband has an enlarged atrium.. that

automatically dismisses him as a candidate for lone afib... he's already got

some structural changes, but it still doesn't change the treatment.

There are a number of terminiologies bandied about when it comes to afib..

some are related, some are not.. some are used interchangably when they

shouldn't be. I'll jot them here, since I've received comments in the past that

they are helpful.

Lone afib = afib with no underlying structural heart problems causing the afib

Paroxsysmal afib = afib that starts and stops spontaneously

Persistent afib = afib that needs help, whether chemically or electrically, to

stop

Permanent or Chronic afib = afib which does not respond to chemicals or

electricity, and therefore does not stop

people frequently interchange persistent, permanent and chronic, although the

difference between persistent and the other two is quite great. It's also hard

to label your self paroxsysmal, v persistent if you are on medication.

Paroxsysmal really only describes someone who is not medicated, yet who goes in

and out of afib by themselves. Once you're medicated the line gets a little

fuzzy there.

So technically one could have Lone, Permanent afib... just means they are in

afib all the time with no other heart problems. Or you could be Lone

Persistent.

And unfortunately many of us initially diagnosed with " lone " don't stay that

way long, since frequent afib has a tendency to change the heart structure.

stef