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Most AF triggers are easily modifiable lifestyle choices
A personal survey of patients with atrial fibrillation (AF),
one of the most important causes of irregular heartbeats,
has found that the majority of triggers for the condition are
easily modifiable lifestyle choices, including alcohol, caffeine,
exercise and lack of sleep.
The findings, identified by researchers at the University
of California, San Francisco, in collaboration with patients
and advocates, indicate potential ways to prevent and reduce
AF episodes. ‘Almost all AF studies have to do with
risk factors for the initial development of the disease,’
said senior author Dr Gregory Marcus, a UCSF Health
cardiologist and associate chief of cardiology for research
in the UCSF division of cardiology. ‘This study focuses on
specific exposures that cause an individual episode to occur.’
In AF, electrical impulses in the upper chambers of the
heart are chaotic, causing the atrial walls to quiver rather
than contracting normally in moving blood to the lower
chambers. As a result, blood clots may form. One in four
adults over age 40 years is at risk for AF, with a projection
of nearly six million people in the USA having the condition
by 2050.
AF is one of the leading causes of stroke, but often has
no symptoms and can remain undetected until a stroke
actually occurs. Earlier detection would enable the use
of anticoagulation therapy to mitigate the risk of stroke
and other complications, such as dementia, chronic kidney
disease and heart attack.
Previous research has focused on determining predictors
of AF development, which are known to include being
older, male and white; having multiple cardiovascular
co-morbidities; and lifestyle factors such as alcohol and
smoking. Little is known about acute exposures influencing
specific episodes.
According to Marcus, the idea for this study arose from
a group of AF patients, including author Mellanie True
Hills, CEO of the patient advocacy non-profit
StopAfib.org,
and another, Debbe McCall, who has a Twitter following of
thousands of fellow patients. They are part of the Health
eHeart Alliance, a patient-powered research network involved
in the design, conduct, oversight and results dissemination of
cardiovascular-focused research projects and supported by
the UCSF-led Health eHeart Study.
In this study, the researchers surveyed 1 295 AF patients
from the Health eHeart Study and
StopAfib.org,asking
them whether they had experienced an AF episode triggered
by one of 11 potential triggers that had been identified by
an AF patient review board. Participants also could write in
their own triggers.
Nearly 74% (957) reported AF triggers. The most common
were alcohol (35%), caffeine (28%), exercise (23%) and lack
of sleep (21%). Younger patients, women and those with
AF family history were more likely to report experiencing
irregular heartbeats after triggers.
On average, patients reported experiencing reactions
to two different triggers. Women, Hispanics, those with
obstructive sleep apnoea and patients with an AF family
history reported a greater number of triggers. Patients with
AF triggers had 71% lower odds of congestive heart failure
and more than a two-fold greater odds of AF family history
compared to those without triggers, based on Health eHeart
Study data.
Marcus said the study revealed a need to explore the
impact of these common exposures on a broad range of AF
patients, including a possible connection to underlying genetic
differences. ‘Better understanding of individual-level triggers
may help empower patients and represents a novel approach
to improving quality of life and reducing healthcare use
for AF,’ said Marcus, holder of the endowed professorship
of AF research in the UCSF School of Medicine. ‘For
those with an AF family history, understanding gene–
environment interactions may reveal novel mechanisms and,
ultimately, help to counsel patients regarding the best lifestyle
interventions.’
The next step, Marcus said, is to launch an app-based
study to anyone with intermittent (paroxysmal) AF and a
smartphone to systemically test their triggers. Called I-STOP-
AF (Individualized Studies of Triggers of Paroxysmal
Atrial Fibrillation) and funded by PCORI (Patient-Centred
Research Outcomes Institute), the six-week study will include
periods of trigger exposure and elimination in about 500
participants and ask them to track AF symptoms along with
their exposures. Marcus expects to launch the study this year.
Source:
Medical Brief 2019