Doctors could do better at reducing irregular heartbeat risks

About 10 million people on the Chinese mainland suffer from atrial fibrillation (AF), the most common type of irregular heartbeat, a leading cause of stroke, experts warn. Among the population, the disease's prevalence now stands at 0.77 percent but the risk increases with age, says Hu Dayi, director of the Center of Cardiology at Peking University People's Hospital in Beijing. Roughly one out of five seniors over 75 years old has the condition. "Besides symptoms such as fainting, chest pain and congestive heart failure, AF patients tend to have a substantially increased risk of stroke, about seven times that of the general population," Hu said at an event held by the Chinese Medical Association and pharmaceutical company Bayer. Currently, 25 percent of the annual total deaths on the Chinese mainland are caused by strokes and it is AF that leads to 20 percent of all stroke cases, according to Ma Changsheng, who heads the cardiology department of Beijing Anzhen Hospital. Worse, "the strokes caused by AF are twice as likely to kill or disable the sufferers compared with other kinds of strokes", Ma adds. With proper medical intervention, the number of deaths related to AF, a condition that is easily detected and treated, could largely be reduced, he notes. To improve the situation national health authorities and academic societies have published clinical guidelines instructing medical doctors on how to deal with AF. "Anticoagulation drugs like warfarin are proven to be effective in lowering the chance for strokes among AF patients by at least half and the use of them has for long be prescribed in clinical guidelines for the condition. But the practical implementation is very poor in China," Ma says. To date, only 5 percent of AF patients on the mainland adopt warfarin therapy, far lower than the 55 percent figure in the United States, he says. "Health risks related with warfarin prevent clinical doctors, particularly at grass-roots levels, to administer the medicine," he explains. Major health impacts of the anti-clotting agent warfarin include nausea, vomiting, diarrhea, and most importantly, bleeding. "Regular blood tests and doctor visits have to be taken for warfarin recipients to make sure that patients receive the right dose of the drug and don't develop bleeding problems," he says. Given the limitations regarding medical facilities, capacity of medics, particularly at community levels, and government investment, "many doctors avoid prescribing warfarin for patients for fear of possible bleeding," Ma explains. Hu adds that financial incentives among doctors are also to blame. "Warfarin is cheap and carries certain risks without proper follow-up services, including regular blood tests, so many medics don't bother to administer it," Hu notes. A practical compromise for AF patients at relatively lower risk of a stroke is aspirin, another anti-clotting drug, experts suggest. It is not as effective as warfarin, but is less likely to cause serious bleeding. "It takes time to improve the situation," Ma says, adding improving the ability of doctors, particularly at community level clinics, is the first step to address the problem.