Stroke is the third most common cause of death and a leading cause of disability in Scotland. Now we have an important opportunity to save lives by tackling atrial fibrillation (AF), one of its major causes.
AF is one of the most common types of irregular heart rhythm and people with it are at a five-fold increased risk of having a stroke, which can have a devastating impact on individuals and families. However, nearly a third of people with AF are unaware they have the condition.
In the year 2015/16, nearly 9,000 people in Scotland had a stroke. We know that more than 96,000 people in Scotland have been diagnosed with AF. However, it’s estimated that 2.6 per cent of the Scottish population, around 145,000 people, have the condition. This means that nearly 50,000 people in Scotland are living with undiagnosed AF and missing the opportunity to reduce stroke risk through appropriate treatment. As Scotland’s population ages, the numbers are likely to increase.
It’s vital that healthcare professionals identify people with AF, who are at high risk and that these newly-diagnosed individuals, and everyone who has already been diagnosed, receives appropriate treatment.
Appropriate use of anticoagulation can cut stroke risk in AF by two-thirds, but the use of these medications is not at the optimum level in Scotland and the report explores reasons why this might be and what could be done to improve that situation. Scotland now has a fuller picture of the impact and implications of having AF thanks to a ground-breaking inquiry carried out by the cross-party group on heart disease and stroke in the Scottish Parliament.
The group is made up of MSPs, clinicians, patients and third sector organisations. Three health charities – British Heart Foundation (BHF) Scotland, Stroke Association and Chest, Heart &Stroke Scotland provide the group’s secretariat.
The group wanted to better understand the key issues around AF and how to drive positive change. It formed an advisory panel to guide an inquiry into the condition and produced its ground-breaking report on 23 January. The report is the first of its kind in Scotland and makes ten recommendations to the Scottish Government.
The panel included clinical and academic experts, people with AF, MSPs and the three health charities. A 12-week consultation last summer attracted 59 responses from people living with AF and 203 responses from clinicians and there were a series of round-table discussions which also informed the report’s recommendations.
This inquiry is ground-breaking in the way it has brought together interested parties, people with AF and health care experts. The number of people engaging with it surpassed the group’s expectations and everyone who contributed helped to inform this inquiry.
At the heart of its recommendations is that we need to find ways to detect people with AF who are at highest risk of stroke and also ensure that clear and consistent clinical pathways exist to optimise the treatment and management of everyone diagnosed.
The report does not suggest national screening but rather encourages support for more local and targeted case-finding programmes, to ensure that every contact with a health and social care professional counts. It suggests that investment in technology and addressing the shortage of cardiac physiologists are key factors to improve the detection and diagnosis of AF. It also suggests that the implementation of specialised services could ensure that people with AF receive accurate diagnosis and prompt, person-centred treatment.
The report highlights many local examples of excellent care, good practice and innovation and recognises and congratulates the health care professionals who are delivering this. However, it also identifies that health care professionals need access to good quality information to empower patients to understand this long-term condition.
People with AF who took part also highlighted the importance of receiving good quality information and stressed the value of the relationships with the health care professionals involved in delivering it.
The cross-party group hopes that the publication of this report marks the beginning of a collaborative effort to tackle atrial fibrillation in Scotland.
For more information about living with AF, contact CHSS advice line nurses on 0808 801 0899.
Kylie produced the report, A Focus on Atrial Fibrillation in Scotland, on behalf of the advisory panel. The report can be downloaded at www.bhf.org.uk/atrial-fibrillation-inquiry and for hard copies please contact BHF Scotland on 0131 561 3362.