European cardiologists highlight risk of delayed diagnosis for patients with non-valvular atrial fibrillation


Daiichi Sankyo and the Heart Rhythm Society have announced the results of the European analysis of a global cardiology survey, which highlights that despite an increase in the number of non-valvular atrial fibrillation (NVAF) patients compared to five years ago (recognized by 76% of cardiologists), nearly all cardiologists (97%) believe there is a delay in patients reaching diagnosis.

The survey findings, released during AF Aware Week (24-30 November 2014), reveal the importance of patients recognising the signs and symptoms of stroke. An acute stroke is a common first sign of atrial fibrillation and over half of European cardiologists (56%) believing that education is the most important type of support an NVAF patient can receive.

Conducted online by Harris Poll in July and August 2014 on behalf of the Heart Rhythm Society and Daiichi Sankyo, the survey involved 1,100 cardiologists from seven countries, including France, Germany, Spain and the UK within Europe.

The primary reason identified by cardiologists for the potential delay in diagnosis was that patients do not seek treatment because they are asymptomatic (cited by 83% of cardiologists in Europe). Low patient and physician awareness of NVAF and confusion about the different types of NVAF (paroxysmal, persistent, long-standing persistent and permanent) and how they can be diagnosed, were also attributed to the delay.

Atrial fibrillation patients have a five-fold increased risk of stroke compared to the general population. Atrial fibrillation-related strokes have been found to be nearly twice as likely to be fatal as strokes in patients without the condition. There is also a poorer prognosis, with an almost 50% increased probability of remaining disabled.

“It is important to note that while cardiologists are recognising the individual nature of patients and delivering bespoke treatment plans according to their needs, it is taking too long for patients to reach this diagnosis,” says A John Camm, professor of clinical cardiology at St Georges University of London and fellow of the Heart Rhythm Society. “This means that patients are not receiving important treatment soon enough and are being put at an increased risk of other complications such as stroke, with potentially fatal implications.”

Identifying the broad spectrum of people diagnosed with and treated for NVAF, the survey reveals that half of European cardiologists (50%) believe there is no such thing as a typical NVAF patient. Over three-quarters of respondents (86%), recognise the diversity of patients, reinforcing the need to focus on individual patient characteristics and their co-morbidities to provide the appropriate disease management. On average cardiologists in Europe reported that their NVAF patients have around three co-morbid conditions. One such co-morbidity, stroke, is a significant concern and one in five are as a result of atrial fibrillation.

It was revealed that when choosing a treatment for stroke prevention, multiple factors are important or very important to cardiologists, including patient risk of bleeding (95%), patient compliance (90%), patient relevant co-morbid conditions (85%) and patient preferences (52%). Significantly, over two thirds of cardiologists (68%) noted that a high bleeding risk is a reason why some patients do not receive any oral anticoagulation therapy for stroke prevention.

Nearly nine out of ten cardiologists (87%) agreed that patients need better education regarding the stroke risks associated with NVAF. The majority of cardiologists reported that in addition to managing the medical aspects of their NVAF patients’ condition, they also ensure that their patients understand their diagnosis (81%) and the importance of taking their medication regularly (89%).

“NVAF is a growing concern, not just across Europe but worldwide,” comments Camm. “The findings of this survey reveal that while advances have been made and a more personalised approach is taken to management, there are still delays in diagnosis which can have a far-reaching impact and more must be done to address this.”