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A new millennium epidemic – the growing burden of atrial fibrillation



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Gabriele Fischetto, Vice President, Johnson & Johnson Cardiovascular Specialty Solutions, EMEA explains why AF is causing so much misery all over Europe

Cardiovascular disease (CVD) remains a leading cause of death across Europe, accounting for 45 per cent of all deaths, approximately 3.9 million every year. But did you know that Atrial fibrillation (AF), a common heart rhythm problem, is fast becoming one of Europe’s most significant health issues, affecting approximately 11 million people across the region? It represents not only a burden for patients, but places an increasing critical pressure on European health systems, estimated to cost up to €3,286 million a year. It may also surprise many to know that AF is now almost as common as cancer and stroke across Europe. 

AF is characterized by an irregular and often fast heartbeat that results in uncoordinated contraction of the top two chambers of the heart and can be a debilitating disease with life-threatening complications. Patients have a five-fold increase in heart failure, 2.4-fold increase in stroke and two-fold increase in cardiovascular mortality risk. Unfortunately, it is known to be a progressive disease, which worsens over time, but early detection and diagnosis may help improve patient outcomes. This element of early detection is a key factor that we have sought to highlight in a report we have recently published. Earlier detection leads to earlier treatment which is not only good for patients but can help reduce the high costs of emergency care and in treating complications and co-morbidities associated with AF. Yet still, one in five patients progress in the severity of their AF within a year.

The financial implications

Through our new report: The Burden of Atrial Fibrillation: Understanding the Impact of the New Millennium Epidemic Across Europe, we aim to shed light on the growing scale and impact of AF across Europe, to renew focus on this health topic and to protect more people from its life-threatening complications, as well as to reduce its economic burden. We found that European healthcare costs associated with AF are estimated to be up to 2.6 per cent of total annual healthcare expenditure in European countries. When this financial reality is factored alongside the prediction that Europe will have the greatest number of AF patients compared to other world regions by 2050 the need for action and improvement becomes even more pressing.

Projected estimates suggest that by 2030 the number of people with AF will increase by up to 70 per cent, which can be closely associated with our rapidly ageing population. Most patients with AF have other serious conditions; and a third will have at least three other conditions.

A key conclusion of the report is that data on AF is not up-to-date. There is a significant lack of recent and robust studies into the epidemiology as well as cost of burden data and up-to-date research on the risks, causes and treatment outcomes relating to AF. For example, most of the evidence on the national or regional burden of AF is based on data collected over 10 years ago and is therefore outdated. The lack of recent, robust data suggests that despite AF becoming a growing burden, it is considered a low priority on government health agendas.

Gabriele Fischetto

A neglected disease

We believe that this behaviour of low prioritisation in both research and patient populations must change, as the sheer impact of AF on the European patient population and the resulting economic and patient burden is something that needs addressing.

Other findings in the report break down the specifics of the high costs of AF management – direct costs such as hospitalisation, outpatient visits and prescriptions and indirect costs such as loss of work productivity and caregiver support. Direct costs are the highest and are similar across France, Germany, Italy and the UK.

Aside from the burden on healthcare systems, the report draws attention to the impact of AF on patients and caregivers. AF can place a significant burden on patients, with up to 47 per cent reporting a reduction in quality of life. With disease progression, patients with AF are more likely to experience more severe mobility problems as they age, problems with self-care, increased pain and discomfort as well as anxiety and depression. Caring for family members with AF can be extremely burdensome with caregivers experiencing considerable changes to their daily lives as well as high risk of burnout when caring for patients who are frail, sick and debilitated. 

Awareness and improved knowledge of AF across general populations is key to support earlier detection, diagnosis and better management of this condition. An international study found that 45 per cent of patients incorrectly believed AF is not a life-threatening condition. A consistent drive to enhance detection rates is needed together with a multi-disciplinary approach involving both primary care physicians and secondary care specialists to diagnose, treat and manage AF optimally.

We will continue to participate in global AF Aware initiatives alongside patient associations and other bodies and we hope that this report will further contribute towards a movement for better knowledge and action around AF. For over 20 years, Biosense Webster has led the science of diagnosing and treating heart rhythm disorders. We have partnered with clinicians to develop innovative technologies that improve the quality of care for arrhythmia patients worldwide and we remain committed to this cause as we call for the urgent need to focus on this disease so that we can all work together to tackle it head on and heal more hearts.

About the author

With well over 100 years experience between us, we've been around the editorial and medical blocks a few times. But we're still as keen as any young pup to root out what's new and inspiring.

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