Peter Kowey, MD: Undiagnosed atrial fibrillation may be common

The incidence of undiagnosed atrial fibrillation (AF), a type of irregular heartbeat, may be greater than most physicians realize, according to a new study co-authored by Peter R. Kowey, MD, cardiologist at Lankenau Heart Institute in Lankenau Medical Center, and the William Wikoff Smith Chair in Cardiovascular Research at Lankenau Institute for Medical Research.

In a three-year, multi-center clinical study, Dr. Kowey and his colleagues showed that continuous monitoring of a previously undiagnosed at-risk population uncovered AF in nearly 40 percent of patients. The results are significant because, in many patients, the symptoms of AF are silent or minor. AF markedly increases a patient’s risk of having a stroke.

“I’m beginning to think of atrial fibrillation as an epidemic,” said Dr. Kowey. “Our population is aging and has many of the risk factors for the disease. We may be seeing the early signs of a perfect storm.”

In the study, 385 undiagnosed at-risk patients were fitted with miniature implantable recording devices. The detection rate for AF rose through the study’s length.  At 18 months, almost 30 percent of study participants were found to have AF. After two years of wearing the device, 33 percent of participants were found to have AF.

“We know that AF is a progressive disease,” said Dr. Kowey. “As such, it seems appropriate to suggest that aggressive monitoring of at-risk populations by clinicians is warranted, because we now know that a significant percentage of them will have AF.”

Patients’ symptoms can be well managed with anti-coagulant medications, said Dr. Kowey. “We can treat AF, which reduces the patient’s risk of a stroke. In fact, this is one area where the medical community can have a major impact on the health of a large number of people: diagnosing atrial fibrillation and treating it to reduce the incidence of catastrophic stroke.”

The results of the study, “Incidence of Previously Undiagnosed Atrial Fibrillation Using Insertable Cardiac Monitors in a High-Risk Population: The REVEAL AF Study,” were published in a recent issue of the biomedical journal JAMA Cardiology.

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