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Stroke risk
December 29, 2018 03:17PM
Direct quote from StopAfib.org

"If you have atrial fibrillation, your odds of avoiding stroke aren't that good — atrial fibrillation increases your risk five-fold, and about one-third of atrial fibrillation patients will actually have a stroke. And your risk increases even further if you have other stroke risks, such as heart disease, high blood pressure, obesity, smoking, high cholesterol, or excessive fat intake. If you get enough physical activity, your stroke risk decreases, but atrial fibrillation often leaves you weak and without the stamina for physical activity."

I've read those statistics before but I thought that once you are on a blood thinner your risk was pretty much the same as the general population. Plus, what about the people who don't have afib and have a stroke. Isn't that a much greater number? It just seems like that first sentence is a little misleading.



Edited 2 time(s). Last edit at 12/29/2018 03:19PM by katesshadow.
Re: Stroke risk
December 29, 2018 05:32PM
No, it's not misleading. If you have afib, your stroke risk is about 5% per year on average, with that risk rising as your CHADS-Vasc goes higher (eg, the risk is 10% for a CHADS-VASC of 6). People without afib have about a 1% risk on average, so in fact it is about five times higher. If you take an anticoagulant, that cuts your risk roughly in half. It does NOT reduce it to the same level as someone without afib. (If you want to reduce your risk to that level, you need to have a left atrial appendage occlusion device inserted or to have your LAA surgically removed/closed.)

Sure, in sheer numbers people without afib have more strokes than people with, but that's just because only about 5% of the population has afib. You can't really compare the two groups in terms of raw numbers because the non-afib group is 20 times bigger.
Re: Stroke risk
December 29, 2018 08:01PM
Quote
Carey
. (If you want to reduce your risk to that level, you need to have a left atrial appendage occlusion device inserted or to have your LAA surgically removed/closed.)
.

Which, while certainly warranted in advanced cases, is sort of a “nuclear option” and likely nowhere near what the original poster needs at this point in time.

We like to say a-fib is a journey and what Carey’s describing is at the end of a very long road.
Re: Stroke risk
December 29, 2018 10:19PM
That's why I put it in parentheses. Just saying what you would need to do to reduce your risk to the same as someone without afib.
Re: Stroke risk
December 30, 2018 09:38AM
Here is a stroke risk calculator from UCLA. You can change different variables (including BP, diabetes, CVD & afib) and see how it impacts your risk <[www.uclahealth.org]

BTW on Carey's 5%/year - looks a little steep on some of the cases I ran. In one comparison, the 10 year risk went from 1.1% to 4.3% a very material increase, but not 5%/year.
Re: Stroke risk
December 30, 2018 09:45AM
That's why I don't fear taking a blood thinner, despite my CHADs score = 0.
Re: Stroke risk
December 30, 2018 12:49PM
Carey,

Do you know why afibbers are at a greater risk than non afibbers?
Please exclude LAA surgically removed/closed because you can still have a stroke even with that done..
Re: Stroke risk
December 30, 2018 05:13PM
Quote
colindo
Do you know why afibbers are at a greater risk than non afibbers?

Not really, no. That's one of the million dollar questions in cardiology these days. It's not really understood fully, but there's a growing consensus that there's an underlying atrial substrate that makes strokes more likely just as it makes afib more likely. The general term being used is atrial myopathy. What exactly atrial myopathy actually is isn't fully understood, but it's probably a combination of increased fibrosis and changes at the cellular level.
Joe
Re: Stroke risk
December 30, 2018 05:43PM
Quote
GeorgeN
Here is a stroke risk calculator from UCLA. You can change different variables (including BP, diabetes, CVD & afib) and see how it impacts your risk <[www.uclahealth.org]

BTW on Carey's 5%/year - looks a little steep on some of the cases I ran. In one comparison, the 10 year risk went from 1.1% to 4.3% a very material increase, but not 5%/year.

That's really cool, George! Hope they are right but i won't rely on the result:
Total Points: 11 out of 30

Your 10-Year Stroke Probability is 11.2%

Average 10-year Probability based on your age group is 13.7%

Your Risk of Stroke is lower than the average person at your age.
Re: Stroke risk
December 30, 2018 08:44PM
Quote
Carey
That's why I put it in parentheses. Just saying what you would need to do to reduce your risk to the same as someone without afib.

And I got that. Just wanted to make sure everyone else did. thumbs up

We are an advanced site here, willing to offer advice sometimes even beyond what some EPs will. And that’s awesome, by the way. But part of me fears we might overwhelm newcomers with too much information at the outset. So I was only trying to “color comment” as it were.

Relax, folks! Not everyone needs their left atrial appendage (LAA) isolated. But if your EP tells you it either won’t work or won’t help you, be sure to check here first! grinning smiley
Re: Stroke risk
December 31, 2018 02:44AM
Quote
Carey
No, it's not misleading. If you have afib, your stroke risk is about 5% per year on average, with that risk rising as your CHADS-Vasc goes higher (eg, the risk is 10% for a CHADS-VASC of 6). People without afib have about a 1% risk on average, so in fact it is about five times higher. If you take an anticoagulant, that cuts your risk roughly in half. It does NOT reduce it to the same level as someone without afib. (If you want to reduce your risk to that level, you need to have a left atrial appendage occlusion device inserted or to have your LAA surgically removed/closed.)

Sure, in sheer numbers people without afib have more strokes than people with, but that's just because only about 5% of the population has afib. You can't really compare the two groups in terms of raw numbers because the non-afib group is 20 times bigger.

Here's a good discussion of stroke risk for AFib from John Day. In some of the studies he mentions that the stroke risk for people with successful ablations are reduced to the same level as those with no AFib. I'm sure there's not general agreement on this but worth noting.

[drjohnday.com]
Re: Stroke risk
December 31, 2018 11:52AM
Quote
wolfpack

That's why I put it in parentheses. Just saying what you would need to do to reduce your risk to the same as someone without afib.

And I got that. Just wanted to make sure everyone else did. thumbs up

We are an advanced site here, willing to offer advice sometimes even beyond what some EPs will. And that’s awesome, by the way. But part of me fears we might overwhelm newcomers with too much information at the outset. So I was only trying to “color comment” as it were.

Relax, folks! Not everyone needs their left atrial appendage (LAA) isolated. But if your EP tells you it either won’t work or won’t help you, be sure to check here first! grinning smiley

Do those of you who have been diagnosed for years think about your Afib very often?

Because, right now it is ALWAYS in the back of my mind.....so depressing.
Re: Stroke risk
December 31, 2018 12:23PM
Here are my calculations but I still have to take a blood thinner because I am missing a A wave after LAA isolation.



Total Points: 8 out of 30

Your 10-Year Stroke Probability is 7.3%

Average 10-year Probability based on your age group is 7.8%

Your Risk of Stroke is lower than the average person at your age.
Re: Stroke risk
December 31, 2018 01:38PM
Quote
katesshadow

Do those of you who have been diagnosed for years think about your Afib very often?

Because, right now it is ALWAYS in the back of my mind.....so depressing.

I've had afib for 14 1/2 years. The remission protocol I use is one I created and was approved by an EP during a 2.5 month persistent episode which started about 2 months after my initial paroxysmal episode. With some variation, this has been successful enough that my afib burden is very low (0.2 - 0.01% depending on the year). I do pay attention with a high attention to detail to following my protocol (a high level of magnesium supplementation, detraining from endurance exercise while maintaining excellent fitness, supplementation with potassium citrate or bicarbonate and taurine, keeping my metabolic variables in check - excellent blood sugar and blood pressure). I can sense my heart by just putting my attention on it. I know immediately if I have an issue and will either take flecainide on demand to convert, or more recently using an exhale breath hold to increase serum CO2. I do sample once a day with a Kardia device, though this really isn't needed - I do it mostly to record that I am in NSR and if I ever needed a cardioversion, I could show the data to the ER folks to demonstrate I haven't been out of rhythm long.

I am very physically active and I can do almost everything I want as long as I don't do long duration high intensity activity (my issue is the product of duration and intensity - I can do long duration, low intensity or short duration high intensity without issue). Because of this, I don't consider it depressing at all. I'm grateful I have a chronic illness that does not limit me much. I make sure I take my requisite magnesium daily - without doing that, I'm in afib quickly. I do avoid long duration, high intensity activity (I don't skin up and ski down, for example). I do make sure my blood sugar and blood pressure are at the very low end of normal. The latter two have health benefits far beyond afib. I routinely water fast 7 or so days, for example.

George
Re: Stroke risk
December 31, 2018 03:38PM
You are very diligent winking smiley.

I think I just have fear of the Afib and how scary the episode was to me . Most things I've read say it's not harmful, if controlled. Control just means the rate is not over 100, no matter how long it lasts? And, certainly, only good can come from trying to make better health choices. Perhaps I should view the AFib as a wake-up call. Maybe those Afibbers who are taking better care of themselves are actually healthier than the general population.
Re: Stroke risk
December 31, 2018 08:04PM
Quote
katesshadow
Control just means the rate is not over 100, no matter how long it lasts?

That’s the definition of rate control, yes. It means you won’t be at risk of heart failure, which is a thickening of the ventricular walls due to the excessive beating.

It doesn’t lower stroke risk. That remains elevated as long as the atria are not contracting normally.
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