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Senior Life: Tips for Healthy Living - Atrial Fibrillation

     Three years ago, I was traveling with my 75 year old mother out of state to attend my niece’s dance recital. My mother had been relatively healthy up until this point, with only a history of breast cancer back in her early 50’s. As the weekend progressed, she kept complaining about how tired and sluggish she felt, often complaining of shortness of breath. Being a pharmacist, I did my best to assess her symptoms, thinking first that it sounded like a respiratory problem.

     She continued on through the day with only mild symptoms, but as the weekend progressed, so did her symptoms. During our drive home, her shortness of breath had worsened to where she would lay back and breathe through pursed lips, but then after a few minutes, it would seem to return to normal. I was very confused, as I was still considering a respiratory type infection and didn’t understand why it would come and go like that.

     At one point we pulled over and I checked her pulse (heart rate). It was 118, which was elevated, especially considering that she was only sitting in the car at rest. I wondered if this might be related to the stress of an infection or just not feeling well, but now the thought of a heart problem was finally formalizing in my head. We went to the emergency room upon our arrival back home, where she was found to have Atrial Fibrillation (AFib). She was started on some new medications, which my mother thought would only be needed temporarily. Unfortunately, like many others, her atrial fibrillation has persisted and based on her risk for complications from the AFib, she will continue on them for possibly the rest of her life.

     I decided to share this story and the information to follow because atrial fibrillation is common in older adults and we often see our patients taking several medications to help control the condition. Many ask, are these all necessary? Will I ever get off of them? These are the questions I will attempt to answer in the following paragraphs.

     Atrial fibrillation (AFib) is an irregular beating of your heart, caused by a defect in the electrical wiring of the heart. When the upper chambers of the heart (the atria) beat too fast and irregular, the blood doesn’t get pushed out to the rest of the body like it normally would. This is when symptoms like what my mother experienced may occur, including shortness of breath, fatigue, dizziness, and weakness. A person in AFib might also feel their heart pounding in their chest or could even experience chest pain. These symptoms can start to affect your quality of life by limiting your ability to get around as you normally would. Additionally, a person in AFib is at a much higher risk of having a stroke. The blood that pools up in the atria of the heart is more prone to forming blood clots and if dislodged, they can travel to the brain causing a stroke. Patients with untreated AFib are 5 to 7 times more likely to have a stroke! Finally, because the AFib makes your heart pump erratically, the muscle can weaken over time, potentially leading to heart failure. For these reasons, AFib should be taken seriously. Patients with AFib can live long, healthy lives by working with their providers to find the most tolerable and effective regimen to treat their AFib.

     Atrial fibrillation can either be persistent, where the heart is in the abnormal rhythm all of the time or it can come and go, which is called occasional atrial fibrillation (paroxysmal), where it jumps between the irregular rate for a few minutes up to several hours, then returns to normal. Providers will order patients to wear monitors at home over a period of a few days to help detect the irregular heartbeat in these cases. Even if your AFib is occasional, you may still need to be treated.

    There are several things you can do to help prevent atrial fibrillation, including getting regular exercise (even just walking most days of the week), eating a healthy, nutritious diet, quitting smoking, and limiting alcohol, caffeine, and stress. If you are diagnosed with AFib, it is recommended to continue these habits, in conjunction with the treatment regimen that you and your provider decide on.

     There are three classes of medications that all play a different role in managing AFib. The first class consists of anticoagulants, otherwise known as blood thinners. Anticoagulants have been shown to significantly reduce the risk of stroke in patients with AFib. Not everyone with AFib will necessarily need to be on a blood thinner, however. This is based on both their risk for stroke and their risk for bleeding, both which are assessed by factoring in age, sex, and medical history. The common blood thinners you may be familiar with include; EliquisTM, PradaxaTM, XareltoTM, SavaysaTM and warfarin (CoumadinTM). It is recommended that most patients who required a blood thinner upon their initial AFib diagnosis, remain on one long term, even if their AFib is well controlled or a normal heart rhythm is restored following a procedure.

     The next two classes of medications for AFib are used to control the rate and rhythm of the heart. Drugs used to slow down the heart rate (to a goal of less than 100 bpm) give the heart the ability to pump the blood out more effectively. Common agents used for rate include the beta-blockers, such as bisoprolol, metoprolol (ToprolTM), and carvedilol (CoregTM) to name a few. The other rate control medications are the calcium channel blockers which include diltiazem and verapamil. Medications indicated to keep the “pace” of the heart on the other hand, are prescribed to maintain a normal rhythm once it is achieved. Some common agents used for rhythm control include flecanide, disopyramide, amiodarone, propafenone, or sotalol, among others.

     These medication classes are carefully selected and monitored by prescribers. If it is deemed necessary to be on one or all three classes, it is important to take them as directed, as they all have a purpose. Talk to your doctor or ask your Lewis pharmacist how to best take your medications to maximize your AFib control!

Written by Heather Storey, Pharm.D, Lewis Drug Clinical Pharmacist

References:

1. Atrial Fibrillation Treatment Guide. Accessed on 9/18/21 at: https://my.clevelandclinic.org... treatment-guides/14-0081-afib-guide.

2. Clinical Resource, A Fib Guidelines: Focus on Pharmacotherapy. Pharmacist’s Letter/Prescriber’s Letter. March 2019

3. Gregory Y. H. Lip, MD; Amitava Banerjee, MD, DPhil; Giuseppe Boriani, MD, PhD; Chern en Chiang, MD, PhD; Ramiz Fargo, MD, FCCP; Ben Freedman, MD, PhD; Deirdre A. Lane, PhD; Christian T. Ruff, MD, MPH; Mintu Turakhia, MD; David Werring, PhD; Sheena Patel, MPH; and Lisa Moores, MD, FCCP. Antithrombotic Therapy for Atrial Fibrillation, CHEST Guideline and Expert Panel Report. CHEST 2018; 154(5):1121-1201

4. January CT, Wann LS, Calkins H, Chen LY, Cigarroa JE, Cleveland JC Jr, Ellinor PT, Ezekowitz MD, Field ME, Furie KL, Heidenreich PA, Murray KT, Shea JB, Tracy CM, Yancy CW. 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation. 2019;140:e125–e151. doi: 10.1161/ CIR.0000000000000665

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