Atrial Fibrillation

CVD
Hypertension
Physical Exercise
Smoking
Healthy Diet
Stroke
Diabetes
Alcohol
Healthy People
Heart Failure
Disability

introduction Introduction

Atrial fibrillation (AF) is a heart condition that causes an irregular and often abnormally fast heart rate. This occurs when the electrical signals from the top chambers of the heart (atria) do not get sent properly. These signals will sometimes quiver or twitch (known as fibrillation), causing the heart to beat abnormally, which means it does not pump blood as well as it should.

A normal resting heart rate should be regular and around 60-100 beats a minute. In AF, the heart rate will be irregular, and can be very fast, sometimes over 100 beats per minute.1

There are 4 types of AF:

  • Paroxysmal: episodes of AF that come and go, but usually resolve within 48 hours without the need for any treatment.
  • Persistent: episodes of AF, with each lasting longer than 7 days (or less when treated).
  • Permanent: AF that is present all the time (usually receiving treatment).
  • Long standing: AF that has lasted for over a year.

Symptoms of AF could be:

  • Dizziness
  • Shortness of breath
  • Tiredness
  • Heart palpitations
  • Chest pain

However, a person may not experience any symptoms and not be aware their heart rate is irregular.

AF may be detected by a health professional during routine appointments when checking your pulse. A diagnosis of AF usually takes place through further tests being completed, such as an ECG, chest X-ray, echocardiogram, and blood tests.

The management of AF can be referred to or known as the ‘four pillars of AFib care’, which is tailored for the individual and may include:

  • Pillar 1: Rate control, use of medication or a pacemaker to prevent or manage the heart beating too fast.
  • Pillar 2: Rhythm control, use of medicine or a medical procedure to return the heart to a normal rhythm.
  • Pillar 3: Stroke prevention, including use of medication such as anticoagulants (blood thinners) to prevent blood clots.
  • Pillar 4: Risk factor management, which focuses on modifying lifestyle factors.2

why is it important to population health Why is it important to Population Health?

AF is important to population health for many reasons:

AF is a priority for the NHS, as well as many local health partnerships, due to AF increasing the risk of stroke, dementia, and heart attack. AF sits within the cardiovascular umbrella of disease, alongside coronary artery disease. Currently, there are approximately 1.4 million people affected by AF in the UK,3 with it estimated that another half a million are undiagnosed.4

The NHS 10-year plan aims to prevent 150,000 strokes, heart attacks and dementia cases.5 Key to this, is improving the detection and management of AF, alongside other associated conditions, such as hypertension and high cholesterol.

Consequences: The main consequence of AF is the close association of wider cardiovascular disease (CVD) and risk of stroke and heart failure.

Health inequalities: Older people, males, being of white ethnicity, and those that live in lower socioeconomic areas are more at risk of having AF.

Risk factors: There are several factors that can increase the risk of developing AF. This may include:

  • Age (above 60 years)
  • High blood pressure
  • Obesity
  • European ancestry
  • Diabetes
  • Pre-existing heart conditions such as heart failure, ischemic heart disease, hyperthyroidism
  • Increased alcohol use
  • Smoking

Population health approaches can help people to make changes to the modifiable risk factors, such as smoking, alcohol intake and healthy diet, which can help reduce the risks of developing AF. However, some people, even those with a healthy lifestyle and no underlying health conditions, can develop AF for reasons unknown, and this is known as ‘Lone Atrial Fibrillation’.

Burden: The number of people diagnosed with a heart rhythm condition (AF) has risen by 50% in the last decade, with AF increasing the risk to a 1 in 5 chance of a potentially fatal or life changing stroke.6 Each year, strokes cause approximately 34,000 deaths and are the leading cause of severe disability in the UK7, with two thirds of those who survive a stroke going on to live with a lifelong disability.8

Economic impact: AF is predicted to cost the NHS between £1435m - £2548m, with those costs expected to rise.9 For those that experience a significant life event of stroke or heart attack, the after-care costs within health and social care for the 5 years after a stroke is estimated to be £46,039 per patient.10

the derbyshire population approach The Derbyshire Population Health Approach

The Derbyshire Population Health Approach focuses on prevention, population health, evidence-informed practices, causes, and collaboration. It emphasises proactive measures to prevent health issues, tailors interventions to specific populations, incorporates evidence-informed practices, addresses underlying causes, and promotes collaboration for effective action.

When considering the topic of AF within The Derbyshire Population Health Approach:

• Prevention Prevention

Whilst the specific cause of AF is not fully understood, AF is more likely to occur in people who already have existing conditions such as high blood pressure or a heart valve problem,11 as well as other comorbidities such as diabetes and high blood pressure. Therefore, early adoption of healthy lifestyle choices is important as this can reduce the risk of experiencing these conditions.

Supporting and addressing early indicators and predisposing factors of AF such as smoking, physical activity and a healthy lifestyle, can help in the prevention of developing AF, and as such reduce the risk of significant life events such as stroke or heart attack.

Derbyshire Public Health offers support via its Live Life Better Derbyshire service for physical activity, smoking cessation and healthy lifestyles, including the offer of the NHS health check, which all promote early awareness and change.

• Population Population

Those aged 65 and over more commonly experience AF, which means that we can expect more people to be affected, due to our growing ageing population.

People from lower socioeconomic areas are at 12% greater risk of developing AF, and have a 26% higher mortality rate, than those living in wealthier areas.12 This is due to the likelihood that people living in these areas also exhibit other lifestyle factors such as smoking and poor diet, that contribute to the development of AF.

Population health approaches aim to reduce these inequalities within our communities, by ensuring that services that can support and positively impact those most at risk, are accessible and available in a way that people can successfully engage with them. This may include taking services out of clinical settings into community venues and utilising existing resources that the community feels confident in accessing or has trust in.

• Evidence Evidence

Current guidelines for AF management support a more holistic approach by applying the better care pathway through the ABC principals:

  • A - Avoid stroke with Anticoagulation
  • B - Better symptom control with patient centred symptom directed decisions on rate or rhythm control, and
  • C - Cardiovascular and Comorbidity management, including lifestyle factors.

Outcomes of an initial clinical trial show that through adherence of the ABC pathway, patients showed reductions of

  • 58% all-cause deaths
  • 63% cardiovascular death
  • 45% ischemic stroke
  • 31% major bleeding13

Trial evidence of the ABC pathway continues to be explored, with risk assessment and re-assessment continuing to be central in the prevention of stroke in AF.

• Causes Causes

The cause of AF is not fully understood, however, certain groups can be more affected than others, such as older people and people living with a long-term health condition, such as heart disease, high blood pressure or obesity.

AF, like many other conditions, can be triggered by lifestyle factors, such as drinking too much alcohol or smoking. Therefore, it is important to increase awareness to the population of the connection between lifestyle and AF (and its associated conditions) via promotional resources and incorporating lifestyle advice in support of positive change.

• Collaboration Collaboration

Collaboration of services, whether within existing networks or establishing new ones, is vital to supporting the population health of our local communities. There is the need for experts to offer guidance and evidence, as well as those that will be involved in front line delivery of services and support, such as pharmacies, health care professionals, Integrated Care Board (ICB), voluntary sector, etc. Agreed shared messaging and advice is crucial to ensure that information is clear, consistent and understandable to all, in support of early advice and prevention as well as required clinical information. Recognising the strengths of each partner is key to building successful relationships, as a professional network and with the people in the communities we serve, which can be fundamental to the delivery of services and programmes. It is also important to routinely review key stakeholders, ensuring appropriate representation from those that can act as enablers in the system and support new initiatives.

latest derbyshire data Latest Derbyshire Data

Trend Data

Prevalence Maps of Derbyshire

The maps below illustrate Lower Super Output Areas (LSOAs) and Middle Super Output Areas (MSOAs) for Derbyshire. LSOAs and MSOAs are geographical divisions used for statistical purposes, allowing for more detailed analysis of local data. In these maps, you can explore various health indicators and data for Derbyshire, providing valuable insights into the area’s health and wellbeing.

In the top right of the map, you’ll find the ‘Layer Control’ icon. This is an easy way to customise what you see on the map visualisation. Click the ‘Layer Control’ to choose which information is displayed on the map. Pick the indicator that interests you the most, and the map will transform accordingly.

Slope Index

This chart illustrates the differences in health and lifestyle factors across areas in Derbyshire, from the most deprived (decile 1, red) to the least deprived (decile 10, green). As you move from left to right on the chart (from more deprived to less deprived areas), the line shows whether these factors are becoming more or less common. Essentially, it’s a way to see how living in wealthier or poorer areas affects the prevalence of these factors.

further analysis and assessments Further Analysis & Assessments

Derbyshire Joint Strategic Needs Assessment (JSNA) involves a thorough examination of a specific health problem, exploring its causes, consequences, and underlying factors. It combines various data sources, collaboration with stakeholders, and rigorous analysis to generate insights for evidence-informed interventions and policy changes.

more information and resources More Information & Resources

Here is a list of useful resources and information related to physical activity. These materials are meant to provide individuals, healthcare professionals, and communities with the knowledge and tools they need as part of efforts to address physical activity as a population health topic.

Contributors

Stacey Speed, Advanced Public Health Practitioner