How does atrial fibrillation progress?
There is much you can do to lower your risk of developing atrial fibrillation – and to reduce its burden after diagnosis.
Atrial fibrillation is typically divided into the following categories:
Initial diagnosis (first detected episode on an ECG device)
Paroxysmal (episodes come and go, and typically last for less than 7 days)
Persistent (continuous, and episodes last for more than 7 days)
Long-standing persistent (continuous, and episodes last for more than 12 months)
Permanent (is present all the time, and there are no more attempts to restore or maintain normal rhythm)
Understanding the type of atrial fibrillation one has, what the symptoms are and how the condition is progressing impacts treatment and monitoring decisions made by health care professionals.
According to research:
In Europe, ~75% of patients with atrial fibrillation have paroxysmal or persistent atrial fibrillation (1).
1 in 5 patients progress from paroxysmal (episodes come and go) to persistent atrial fibrillation (continuous episodes) within a year of their diagnosis (2).
Early access to treatment has a good prognosis for delaying disease progression (3) and associated complications, such as ischemic stroke and heart failure. This is why early detection is so important.
Atrial fibrillation that presents no symptoms is more likely to progress to persistent faster (4) and increase the risk of health complications due to possibly delayed treatment.
New care guidelines: Better understanding of atrial fibrillation as a progressive disease
New atrial fibrillation care guidelines (5) came out at the end of 2023. The guidelines emphasize atrial fibrillation as a progressive disease where greater consideration should be given to the risk factors (e.g. hypertension, older age, unhealthy lifestyle, diabetes) in providing care.
The guidelines call for heavier emphasis on a healthy lifestyle, the ‘modifiable risk factors’ to prevent disease progression. Prevention, lifestyle changes and screening should be considered for individuals who are at the highest risk of developing atrial fibrillation in the future. CardioSignal makes heart health-related insights available to help people improve their control over modifiable atrial fibrillation risk factors, such as diet and exercise.
Earlier management of atrial fibrillation has the potential to reduce the burden of the disease and adverse health outcomes such as ischemic strokes. This shift from treating complications to earlier detection and prevention is a win-win-win for the individual, the health system, and society at large.
Take control: Even small lifestyles changes can have a big impact
There are many known risk factors for atrial fibrillation. Risk factors are typically divided into non-modifiable risk factors (age, family history) and modifiable risk factors (lifestyle-related factors such as exercising, diet, or managing weight or blood pressure). Researchers, heart associations and care guidelines are increasingly emphasizing the role of modifiable risk factors: What if keeping your blood pressure in check could help you prevent a serious heart condition from developing?
The key message: With lifestyle changes, there is a lot you can do to reduce your risk of developing atrial fibrillation. Every healthy step counts, whether it is choosing the stairs instead of an elevator or reducing your salt intake. Even these small changes can reduce your risk of heart disease. Starting with specific, manageable changes can also help establish a healthy routine.
Even after atrial fibrillation develops, lifestyle changes continue to carry a lot of weight in slowing down the disease’s progression and managing symptoms. This does not mean that a healthy lifestyle can replace treatment and medication guidance by your doctor. What it does mean is that an irregular heart rhythm does not need to render you powerless or prevent you from leading an active life.
Studies have found that lifestyle changes such as losing weight, quitting smoking, a healthier diet, limiting alcohol consumption, maintaining physical activity, and managing blood pressure can significantly improve health outcomes for people diagnosed with atrial fibrillation (6). Taking care of your health can also give you a sense of empowerment.
Findings suggest that after your atrial fibrillation diagnosis:
Targeting at least a 10% reduction in weight can reduce the burden of atrial fibrillation. Preliminary findings suggest that weight loss could be a driver for reversing persistent atrial fibrillation to paroxysmal (8).
Regular aerobic exercise may improve atrial fibrillation-related symptoms and quality of life.
Staying healthier also improves your body’s capacity to handle atrial fibrillation treatment options.
References:
1. Boriani G, Laroche C, Diemberger I, Fantecchi E, Popescu MI et al. (2015) Asymptomatic atrial fibrillation: clinical correlates, management, and outcomes in the EORP-AF Pilot General Registry. Am J Med.2. Get Smart About Afib (getsmartaboutafib.net)3. Gunawardene, Willems. Atrial fibrillation progression and the importance of early treatment for improving clinical outcomes, EP Europace. (2022)4. Dilaveris PE, Kennedy HL (2017) Silent atrial fibrillation: epidemiology, diagnosis, and clinical impact.5. 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines (2023)6. Pathak RK, Middeldorp ME, Meredith M, et al. Long-term effect of goal-directed weight management in an atrial fibrillation cohort: a long-term follow-up study (LEGACY). J Am Coll Cardiol 2015;65:2159-69.7. Fujino, et al. Clinical impact of regression from sustained to paroxysmal atrial fibrillation: the Fushimi AF registry, European Heart Journal (2020).8. Chung et al. Lifestyle and Risk Factor Modification for Reduction of Atrial Fibrillation: A Scientific Statement from the American Heart Association, Circulation (2020).