What is Atrial Fibrillation (AF), and why should women be aware of it?
Atrial fibrillation (AF) is a common heart rhythm disorder affecting millions globally. Because the prevalence increases significantly with age it’s an important issue for health screening and cardiac checks because of the generally long life expectancy for women in Australia. The condition leads to the heart’s upper chambers (the atria) beating erratically which in turn causes inefficiency of the heart pump and a range of health issues. While it can affect both men and women, there are some important aspects that women, in particular, need to know about. AF can cause symptoms like palpitations, shortness of breath, fatigue, dizziness, and chest discomfort. Some people do not get any warning symptoms that they have AF. It is also well known that women may experience different symptoms from men (and different from what is ‘typically described’ in medical textbooks) which can lead to delays in diagnosis for women. If left undiagnosed, AF can lead to a higher risk of stroke, heart failure, heart attacks, dementia and early death.
How does AF impact women differently than men?
Although atrial fibrillation affects both genders, research shows that women may have some unique considerations. On average women tend to experience more severe symptoms from AF, so if the condition is not diagnosed or treated correctly then women may experience poorer health outcomes and quality of life as a result. The likelihood of developing AF increases with age, and since women generally live longer, they may be more susceptible as they get older. We’re going to discuss in more detail shortly about some of the health risks posed by AF but women need to know there is a increased risk of having a stroke with AF that’s even higher than the risk for a man. AF is also linked with causing dementia so these are hugely important issues for healthy living for women in Australia.
What other factors contribute to AF in women?
AF is a significant problem not only because of the health issues that can result but also because it is is frequently caused by other medical and heart conditions. Conditions such as high blood pressure, obesity, sleep apnoea, diabetes, and thyroid disorders can increase a woman’s chances of developing AF. Regular health checks and healthy heart checks for women over the age of 45 can improve the treatment of these conditions and reduce the risk of developing AF, or aid with its early detection. The average age of onset for AF is higher for women than men because it often follows ‘the change of life’. Hormonal changes, particularly following menopause can contribute to AF development.
What are the key risks associated with AF?
One of the major concerns with AF is the increased risk of stroke because blood clots can form in the heart and then travel off to the brain unexpectedly. Around 1 in 10 people who have a stroke caused by AF were not aware they had AF prior to the stroke. Studies show that women with AF face a higher stroke risk compared to men. Not everybody has the same risk of having a stroke so once AF is diagnosed the risk would be assessed by your family doctor or Specialist and a stroke prevention strategy recommended. If the risk is high  then anticoagulant medications (also called ‘blood thinners’) may be prescribed. These treatments reduce the risk of blood clots forming in the heart and travelling to the brain. Importantly anticoagulant medications not only reduce the risk of stroke but also of dementia.
How is AF monitored and managed in women?
Regular monitoring of the heart’s rhythm, overall heart function and close follow-up with a healthcare provider are essential for women diagnosed with AF. Routine tests such as electrocardiograms (ECGs) or Holter monitoring and echocardiogram may be recommended to keep an eye on the heart’s electrical activity and heart pump function. We live in a world of smart technology and ‘wearables’ these days. There is now a range of ECG devices that can be used at home by women to monitor their condition and this includes smart watches which can take your ECG from your wrist with the touch of a button. Many of these devices are actually approved for ‘medical use’ and therefore very accurate. All of this information helps your doctor to ensure the treatment plan is working and allows for timely adjustments if needed.
What are the specific treatments for AF?
We generally talk about 3 aspects to AF treatment:
The first aspect is diagnosing and treating any other heart or medical conditions which have caused AF, as well as addressing other lifestyle risk factors we’ll cover in a moment.
The second aspect is stroke prevention – assessing the risk and potentially recommending anticoagulant medication.
The third aspect is called ‘rhythm control’ and refers to specific treatments to try to maintain the top chambers (atria) in normal rhythm and prevent the erratic beating episodes – this can improve symptoms, improve heart health and is linked with reduced risk of other long term health risks such as heart attacks and early death. The specific rhythm control treatments include rhythm medications (also called antiarrhythmic drugs), cardioversion (brief medical procedure to reset the heart rhythm to normal from AF) and catheter ablation. Catheter ablation treatment has become much more commonplace around the world now for treating AF – it is a keyhole procedure to insert wires inside the heart to treat (‘ablate’) the source of AF and the misfiring electrical signals. While it is not curative it offers superior results to rhythm medications and can often give control of the AF episodes for many years. Another aspect to the rhythm control treatments is that the earlier AF is treated then generally the better the outcomes. Women with AF should be encouraged to discuss and research all of their treatment options to arrive at a personalised plan.
What steps can women take to manage AF?
Managing AF often includes a combination of treatments, regular monitoring of the condition and lifestyle changes. Several lifestyle factors contribute to an increased risk of the onset or worsening of AF over time. Â These include inadequate regular physical activity, obesity and excessive alcohol intake. Addressing these lifestyle issues along with good compliance with high blood pressure and obstructive sleep apnoea treatments are key factors in long term management.
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As a cardiologist leading a very busy life, what daily habits do you prioritise to maintain your heart health?
I subscribe to the ‘morning person’ theory so the first hour of the day is mine to prioritise what happens – we often can’t control what happens at the end of the day and plans can easily de derailed! I take a brisk walk every morning and then turn my time to preparing a healthy, fresh lunch to take to work. Although I might eat out occasionally and have a treat over the weekend I mostly follow a Mediterranean Diet. I eat nuts and beans or pulses several times per week and use olive oil for cooking or on salads during the week. I also am very careful with my salt intake. But research on longevity and heart health also tells us that it’s not just diet and exercise we have to pay attention to because there are important social and psychological pieces of the jigsaw puzzle. We all need to live life with a purpose, have supportive relationships and some type of activity that helps us to destress or feel happy. When you lead a busy life sometimes these end up getting reprioritised to the weekend!
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What advice do you have for the women reading this?
It is a sad fact but there is evidence around the world that women do not receive as good quality care for cardiac conditions as men. This can be due to biases from doctors or in the healthcare system but, in my experience, this sometimes also results from women not prioritising their own health. Women are traditionally the caregivers and nurturers and frequently make sure everyone else in the family is cared for before they look after themselves. This can result in women not seeking or accessing the best treatments for their AF. I also find that women may prefer a different communication and decision-making style to men which can impact outcomes. This includes providing more information for reflection and encouraging research and discussion with family or friends before arriving at a plan. Women reading this will be interested in taking charge of their own heart health. I would encourage them to be proactive about getting a heart health check and if you are diagnosed with a heart condition then research, understand and discuss the options for treatment so that you feel that you are in control of the plan that works best for you.
It was a pleasure interviewing Dr. Phillips and gaining insights from her vast experience. To learn more about her work, you can visit her LinkedIn profile here: Dr. Karen Phillips, or visit the Brisbane AF Clinic.