(Press-News.org) Stroke is the second cause of death worldwide. Atrial fibrillation is the most common clinically relevant cardiac arrhythmia in Europe, affecting approximately 1.5-2% of the general population.1 Prevalence is estimated to double in the next 50 years as the population ages.
Patients with atrial fibrillation have a five-fold increased risk of ischaemic stroke even though around 30% have no symptoms. As blood is less adequately shifted from the heart during atrial fibrillation, blood clots can form and cause large ischaemic strokes. Strokes that occur in association with atrial fibrillation are often fatal, and survivors are left more disabled and at a high risk of a recurrent stroke.
Dr Svennberg said: "There is hope, however, as oral anticoagulant medication reduces the risk of atrial fibrillation related stroke by 64-70%. But more than 50% of high-risk patients with atrial fibrillation do not receive any treatment. We are looking at an epidemic of atrial fibrillation related strokes if nothing is done to improve treatment levels."
The STROKESTOP trial is a mass screening programme of all 75-76 year olds in Stockholm County and Region Halland in Sweden. It aims to identify patients with undiagnosed atrial fibrillation and find out if oral anticoagulation (OAC) therapy reduces their risk of ischaemic stroke.
For the trial, more than 25,000 people born in 1936 and 1937 were randomised 1:1 to screening for atrial fibrillation or a control group. Screening is done at home with a handheld ECG device and takes 1 minute per day for 2 weeks. When atrial fibrillation is diagnosed, patients are offered OAC treatment. Both screening and control groups will be followed prospectively for 5 years for thromboembolic events, bleeding and mortality.
Preliminary results from STROKESTOP are presented today. A year into the trial, 6,496 (50%) of the 13,000 inhabitants in the screening arm agreed to screening for atrial fibrillation. A lower proportion of patients agreed to screening in Stockholm (49%) than in rural areas (65%). Dr Svennberg said: "We will investigate factors related to participation, in an effort to increase uptake."
More than 11% of the screening group had atrial fibrillation. Of these, previously undiagnosed atrial fibrillation was found in 192 (3%) of patients while in 129 (2%) of patients, atrial fibrillation had been diagnosed but they were not on OAC. More than 90% of the patients with undiagnosed atrial fibrillation were started on OAC.
Dr Svennberg said: "We found that 5% of patients in the screening arm had untreated atrial fibrillation. We successfully started oral anticoagulation treatment in more than 90% of the patients with newly diagnosed atrial fibrillation. This should reduce their risk of a stroke by up to 70%. We are still collecting data on patients with known atrial fibrillation but not on OAC."
Professor Mårten Rosenqvist, chair of the STROKESTOP steering committee, said: "Without appropriate treatment atrial fibrillation is a ticking bomb. We hope the STROKESTOP study will show that screening for atrial fibrillation reduces the risk of stroke. Our final results should be available by November 2018."
###
Notes to editor
References
1 2012 focused update of the ESC Guidelines for the management of atrial fibrillation. European Heart Journal. 2012;33:2719-3747.
2 SBU -- Swedish Council on Health Technology Assessment -- report 2013 "Förmaksflimmer- Förekomst och risk för stroke".
About the European Society of Cardiology
The European Society of Cardiology (ESC) represents more than 80 000 cardiology professionals across Europe and the Mediterranean. Its mission is to reduce the burden of cardiovascular disease in Europe.
About ESC Congress 2013
The ESC Congress is currently the world's premier conference on the science, management and prevention of cardiovascular disease. The spotlight of this year's event is "The Heart Interacting with Systemic Organs". ESC Congress 2013 takes place from 31 August to 4 September at the RAI centre in Amsterdam, Netherlands. More information is available from the ESC Press Office at press@escardio.org
Mass screening identifies untreated AF in 5% of 75-76 year olds
2013-08-31
ELSE PRESS RELEASES FROM THIS DATE:
CHADS2 risk score assigns over one-third of stroke patients to low or intermediate stroke risk
2013-08-31
In contrast, a CHA2DS2-VASc score of 0 identifies a subgroup of patients with very low stroke risk unlikely to benefit from anticoagulation treatment.
Professor Nabauer said: "AF is the most frequent cardiac arrhythmia requiring hospitalisation and has a 1-2% prevalence in the general population. AF is associated with a significant risk of stroke with frequently disabling consequences. While oral anticoagulation is very effective in preventing ischaemic strokes in AF, it increases bleeding risk. Identification of patients with low risk of stroke not requiring oral anticoagulation ...
Statins prevent cataracts
2013-08-31
Cataracts are the leading cause of visual impairment worldwide affecting more than 20 million people. Statins are among the most commonly prescribed medications. In the USA they are prescribed to 1 in 3 people over 45 years of age at a cost of $35 billion annually.
Professor Kostis said: "There is persistent concern among physicians and other health care providers about the possible cataractogenicity of statins.1 We therefore investigated the relationship of statins and cataracts in a meta-analysis of 14 studies selected after detailed review of the medical literature. ...
Diabetic stroke risk after AMI drops in 10 year period
2013-08-31
The findings were presented at the ESC Congress today by Ms Stina Jakobsson from Sweden. They reveal that reperfusion therapy and secondary prevention drugs produced the decline and brought stroke risk after AMI closer to that of non-diabetics.
Ms Jakobsson said: "Ischemic stroke following an acute myocardial infarction is a fairly uncommon but devastating event with high mortality. It has long been recognized that patients with diabetes mellitus are at a particularly high risk of complications after an AMI but until now, the risk of ischemic stroke after an AMI in patients ...
Short-term smoking cessation reverses endothelial damage
2013-08-31
Dr Dohi said: "Smokers are twice as likely to have a heart attack as people who have never smoked. Quitting smoking is the most important thing people can do to reduce their risk of cardiovascular disease. But until now, studies have not examined whether the increased risk caused by smoking is completely reversed after smoking cessation."
The current study investigated how the vascular system is altered by smoking and whether the changes can be normalised by smoking cessation. The researchers focused on the effects of smoking and smoking cessation on arterial endothelial ...
Smokers who survive to 70 still lose 4 years of life
2013-08-31
Dr Emberson said: "Despite recent declines in the numbers of people smoking and tar yields of cigarettes, smoking remains the leading preventable cause of death in Europe."
He added: "Previous studies had demonstrated that prolonged cigarette smoking from early adult life was associated with about 10 years loss of life expectancy, with about one quarter of smokers killed by their habit before the age of 70. Stopping at ages 60, 50, 40 or 30 years gained back about 3, 6, 9 or the full 10 years. However, the hazards of continuing to smoke and the benefits of stopping in ...
STEMI incidence falls in southern Switzerland after smoking ban implemented
2013-08-31
Second-hand smoke increases the risk of coronary artery disease and acute myocardial infarction. For this reason, health policies aimed at reducing tobacco consumption and public smoke exposure are strongly recommended.
Dr Porretta said: "Canton Ticino (CT), which is one of the 26 cantons of the Swiss Federation, was the first Swiss canton to introduce a smoking ban in April 2007. We had the opportunity to assess the long-term impact of the smoking ban on the incidence of ST-segment elevation myocardial infarction (STEMI) and to compare STEMI epidemiology with Canton ...
GPs undertreat women with AF
2013-08-31
Amsterdam, The Netherlands – Saturday 31 August 2013: General practitioners (GPs) undertreat women with atrial fibrillation (AF), according to research presented at ESC Congress 2013 today by Dr Pierre Sabouret from France. The analysis of more than 15,000 patients showed that women were undertreated with antithrombotic medications compared to men regardless of their stroke risk and comorbidities.
Dr Sabouret said: "Gender-related differences among outpatients with stable coronary artery disease are well known.1-6 Heart diseases are one of the most important causes of ...
Brain imaging study reveals the wandering mind behind insomnia
2013-08-31
DARIEN, IL – A new brain imaging study may help explain why people with insomnia often complain that they struggle to concentrate during the day even when objective evidence of a cognitive problem is lacking.
"We found that insomnia subjects did not properly turn on brain regions critical to a working memory task and did not turn off 'mind-wandering' brain regions irrelevant to the task," said lead author Sean P.A. Drummond, PhD, associate professor in the department of psychiatry at the University of California, San Diego, and the VA San Diego Healthcare System, and ...
Study reveals the face of sleep deprivation
2013-08-31
DARIEN, IL – A new study finds that sleep deprivation affects facial features such as the eyes, mouth and skin, and these features function as cues of sleep loss to other people.
Results show that the faces of sleep-deprived individuals were perceived as having more hanging eyelids, redder eyes, more swollen eyes and darker circles under the eyes. Sleep deprivation also was associated with paler skin, more wrinkles or fine lines, and more droopy corners of the mouth. People also looked sadder when sleep-deprived than after normal sleep, and sadness was related to looking ...
Red spruce reviving in New England, but why?
2013-08-31
BURLINGTON, Vt., August 30, 2013 – In the 1970s, red spruce was the forest equivalent of a canary in the coal mine, signaling that acid rain was damaging forests and that some species, especially red spruce, were particularly sensitive to this human induced damage. In the course of studying the lingering effects of acid rain and whether trees stored less carbon as a result of winter injury, U.S. Forest Service and University of Vermont scientists came up with a surprising result – three decades later, the canary is feeling much better.
Decline in red spruce has been attributed ...