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ABC Radio National interviews Prof Ben Freedman

Strong link between atrial fibrillation (AF or AFib) and dementia confirmed

A major report, published as the Frontiers Review in CIRCULATION, has confirmed a strong link between atrial fibrillation (AF) and dementia.

The Heart Research Institute’s Heart Rhythm and Stroke Prevention Group Leader Professor Ben Freedman says doctors working together in the AF-SCREEN International Collaboration across 37 countries have found growing evidence to suggest a consistent association between AF, where the heart beats irregularly, and cognitive impairment and dementia.

Peo­ple with AF are at increased risk of demen­tia, and the link is inde­pen­dent of stroke and oth­er risk fac­tors,” said Prof Freedman.

Atrial fibrillation in elderly patients with dementia

“Whether the link is causal is not yet known, but if we knew what to do in people with AF, we might be able to intervene, and reverse the cognitive decline before dementia, which would be a game changer,” said Prof Freedman.

“What we do know is the prevalence of both dementia and AF is expected to increase with the aging population around the globe.

“Projections indicate the number of individuals with AF will increase by 150 per cent over the next four decades, while the incidence of dementia is expected to double every six years.

“It’s therefore imperative we have more research in this area to find out why there’s a link,” he said.

Prof Freedman, who also founded AF-SCREEN International Collaboration, involving 190 members from around the world, said numerous observational studies over the past decade have found an association between AF and cognitive dysfunction ranging from mild impairment to overt dementia.

The aim now is to iden­ti­fy knowl­edge gaps to focus research efforts to pre­vent or delay the onset of cog­ni­tive impair­ment and demen­tia asso­ci­at­ed with AF,” said Prof Freedman.

“The relationship between the two is complex, because they share epidemiologic similarities and several risk factors including older age, hypertension, diabetes, sleep apnoea, coronary artery disease, obesity and excessive alcohol consumption. They also share stroke as a risk (preventable for AF) and risk factor for dementia.

“Earlier diagnosis of AF could be considered a strategy to prevent or delay dementia and stroke.”

Australia is currently part of a five-year trial screening 100,000 people in the UK and locally.

Prof Freedman said while AF itself may not be seen as dangerous by people who have it, it’s important to diagnose and treat it because it increases the risk of other conditions, such as stroke and heart failure.

“In AF, blood circulates in the heart in an abnormal way so there is a tendency for clots to develop. These clots can break off and travel to all areas of the body in the bloodstream, and if a clot blocks the brain artery, this can cause a stroke,” he said.

“Symptoms of AF include an irregular pulse, heart palpitations or a ‘fluttering’ heartbeat, dizziness, tiredness and weakness. However, people often have no symptoms at all or only experience symptoms some of the time.

One in three peo­ple aged over 50 will devel­op AF dur­ing their life­time – the issue is, most peo­ple have nev­er heard of it, and that’s prob­lem­at­ic because it means they don’t know to ask their doc­tor to check for it,” Prof Freed­man said.

Prof Freedman said AF is also a major cause of stroke and is more common in men than women.

“People can live suffering these small, silent strokes, and they don’t even know they are having them. But while they might not notice them, over time they cause a cognitive decline.

“We need to increase awareness of AF, as only 11 per cent of people over the age of 65 are being regularly screened for AF by their GP despite it being a very simple test.

Almost every­one who turns 65 should be get­ting a year­ly pulse check. Cost isn’t a fac­tor – any­one can afford a pulse check.”

Know your pulse: yearly preventive pulse check

The pulse check:

  • To screen for AF, your doctor may do some tests including feeling your pulse or taking an electrocardiogram.
  • While only your doctor can diagnose AF, you can keep an eye on your heart health by regularly checking your pulse.
  • Your pulse can indicate how well your heart is working, how fast it beats, and its rhythm and strength. Keeping a record will help you notice if there is anything different or unusual with your results.
  • A normal pulse, or resting heart rate, ranges from 60 to 100 beats per minute. Your pulse should beat steadily and regularly. A pause or extra beat now and then is normal, but if you notice it is quite irregular, speak to your doctor.

7NEWS report with Prof Ben Freedman

9NEWS report with Prof Ben Freedman

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