Heart DiseaseNeurologyPreventive Medicine


As I’ve reported before, it seems like atrial fibrillation exists in epidemic proportion. If you don’t know someone who has AFib or has had an ablation, you’re in the minority. The percentage of people over age 60 who tell you they have it is mind boggling. A lot of people with AFib are unaware they have it, and are surprised when the doctor tells them their heart beat is irregular.

Many others know when their heart is beating erratically and experience weakness, shortness of breath, reduced exercise tolerance, and even chest pain, as a result.

Although atrial fibrillation is considered a non-fatal arrhythmia, if ignored it can result in very serious consequences. A recent analysis is a case in point. In Alzheimer’s & Dementia: The Journal of Alzheimer’s Association, a large study concluded that women with AFib were three times more likely to experience cognitive impairment, and later dementia, than women without AFib. Over a four-year period of observation, out of 43,630 participants, 4600 were diagnosed with Atrial Fibrillation. Of these folks, 30% became cognitively impaired and 21% developed dementia. Women were three times more likely to experience cognitive decline than men.

Why women and not men? 

The answer has to do with the prescribing of blood thinners, called anticoagulants. Women are not prescribed anticoagulants as often as men because they are diagnosed with AFib later than men. Unfortunately, women’s symptoms are often stereotyped as anxiety or stress and thus ignored and go undiagnosed. Men are diagnosed and treated quickly. For women, this translates into a higher risk of stroke and death. In fact, women with AFib were 3 times more likely to have cognitive impairment and dementia than women without atrial fibrillation. Stroke risk was higher, as well, because of untreated high blood pressure or undetected heart valve problems.

The American Heart Association (AHA), the American College of Cardiology (ACC), and the European Society of Cardiology (ESC) have for years recommended blood thinners for patients with AFib. AFib causes blood to stagnate, or pool, within the heart, and small clots then form. Occasionally, pieces of clot break loose and lodge in the small arteries in the brain. When clots block oxygen-carrying blood to the brain, mini strokes occur, and these present as mild cognitive impairments—thinking and memory problems—which over time progress to full blown dementia.   

The results of this study definitely indicate women, as well as men, need to be put on blood thinners. The strong association between AFib and declining cognitive function demand it, and in today’s world, it’s malpractice not to. Also, doctors need to take women’s symptoms seriously, examine them, have a high index of suspicion for AFib, and treat it appropriately. That means, among other things, anticoagulant therapy for stroke prevention. 

References: https://www.escardio.org/The-ESC/Press-Office/Press-releases/

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