Undiagnosed AFib has been detected in up to 40% of high-risk patients
Most patients with AFib have episodes frequent enough to be detected during a doctor's office or with a 24-hour monitor. However, about 1 in 4 have sporadic ("paroxysmal") episodes that occur at unpredictable times.3 Doctors must therefore rely instead on patients reporting symptoms such as shortness of breath, dizziness, or chest pain before considering further investigation.
If these episodes are asymptomatic, doctors must suspect AFib based on other history and physical exam findings, but even then, the intermittent nature of the disease makes diagnosis challenging. Consequently, up to 40% of AFib cases may go undetected and untreated, leaving patients at risk for complications.4
Over 1 in 5 patients with AFib suffer a stroke before their AFib is diagnosed
For those who survive, the lifelong complications of a stroke can be debilitating, making prevention crucial. Yet, nearly 22% of patients hospitalized for an ischemic stroke were only diagnosed for AFib after the event.5 This issue is even more pronounced in younger patients, with over one-third of new AFib cases diagnosed post-stroke in those younger than 75. This highlights that many undiagnosed cases are slipping through routine care, leading to severe consequences before AFib is identified.
This is the challenge of silent AFib, which is alarmingly common. The same study found that 30-40% of AFib cases are asymptomatic, meaning providers can't rely on patients reporting symptoms.5 Even more concerning, AFib is often the underlying cause of "cryptogenic" strokes — strokes without an apparent cause. Another study discovered that previously undiagnosed AFib was identified in 12.4% of cryptogenic stroke cases after 12 months of follow-up.6
Undiagnosed and under-treated AFib adds billions to medical spending
A study on the economic impact of AFib in the U.S. estimated that undiagnosed, non-valvular AFib adds over $3 billion in annual medical costs.7 These expenses go beyond stroke-related morbidity, encompassing lost work from symptoms like fatigue and malaise, surgery cancellations due to sudden AFib diagnoses, urgent care visits, and hospitalizations. The findings highlight the economic advantage of early AFib detection and treatment.
AFib is very treatable if caught early
Despite the concerning risks associated with AFib, early detection and treatment can drastically reduce its impact. This can involve restoring a regular heart rhythm, improving symptoms, or initiating anticoagulation (i.e., blood-thinning) therapy, which can reduce stroke risk by up to 64% when followed correctly.8-11
Even patients with infrequent episodes benefit from early detection, as studies show that a higher AFib burden significantly increases stroke risk.12 A more individualized understanding of complication management and risk allows for better care decisions and encourages patient adherence to treatment, ultimately preserving quality of life.
Point-of-care digital ECG tools make regular AFib screening more cost-effective
Low-profile, convenient, and digitally enhanced tools like the Eko CORE 500™ Digital Stethoscope can help augment AFib detection by allowing frequent, easy-to-perform ECG assessments during physical or virtual visits. These tools are faster, less cumbersome, and more affordable than traditional 12-lead ECGs or ambulatory monitors, making them particularly valuable for primary and geriatric care providers who often see older patients at high risk for AFib or stroke.
For healthcare professionals not routinely conducting ECGs, the ability to detect irregular heart rhythms using a stethoscope remains crucial. Digitally enhanced stethoscopes like the 3M™ Littmann® CORE Digital Stethoscope amplify sound and use noise cancellation to help clinicians catch subtle irregularities in heartbeats.
Summary
AFib is a common and dangerous heart rhythm disorder that often goes undiagnosed, increasing the risk of stroke and adding billions to medical costs. Early detection and treatment can significantly reduce these risks, and emerging digital tools like ECG-enabled stethoscopes provide cost-effective solutions for regular AFib screening in high-risk populations.
References
1. Sussman M, Di Fusco M, Tao CY, et al. The IMPact of UntReated NOn-Valvular Atrial Fibrillation on Short-Term clinical and economic outcomes in the US Medicare population: the IMPROVE-AF model. J Med Econ. Published online August 20, 2021:1. doi:10.1080/13696998.2021.1970954
2. Colilla S, Crow A, Petkun W, Singer DE, Simon T, Liu X. Estimates of current and future incidence and prevalence of atrial fibrillation in the U.S. adult population. Am J Cardiol. 2013 Oct 15;112(8):1142-7. doi: 10.1016/j.amjcard.2013.05.063. Epub 2013 Jul 4. PMID: 23831166.
3. Zoni-Berisso M, Lercari F, Carazza T, Domenicucci S. Epidemiology of atrial fibrillation: European perspective. Clin Epidemiol. 2014;6:213-220. doi:10.2147/CLEP.S47385
4. Reiffel JA, Verma A, Kowey PR, et al. Incidence of Previously Undiagnosed Atrial Fibrillation Using Insertable Cardiac Monitors in a High-Risk Population: The REVEAL AF Study. JAMA Cardiol. 2017;2(10):1120-1127. doi:10.1001/jamacardio.2017.3180
5. Jaakkola J, Mustonen P, Kiviniemi T, et al. Stroke as the First Manifestation of Atrial Fibrillation. PLoS ONE. 2016;11(12):e0168010. doi:10.1371/journal.pone.0168010
6. Sanna T, Diener H-C, Passman RS, et al. Cryptogenic stroke and underlying atrial fibrillation. N Engl J Med. 2014;370(26):2478-2486. doi:10.1056/NEJMoa1313600
7. Turakhia MP, Shafrin J, Bognar K, et al. Economic Burden of Undiagnosed Nonvalvular Atrial Fibrillation in the United States. Am J Cardiol. 2015;116(5):733-739. doi:10.1016/j.amjcard.2015.05.045
8. Willems S, Borof K, Brandes A, et al. Systematic, early rhythm control strategy for atrial fibrillation in patients with or without symptoms: the EAST-AFNET 4 trial. Eur Heart J. Published online August 27, 2021:ehab593. doi:10.1093/eurheartj/ehab593
9. Dossett ML, Needles EW, Donahue Z, et al. A SMART approach to reducing paroxysmal atrial fibrillation symptoms: Results from a pilot randomized controlled trial. Heart Rhythm O2. 2021;2(4):326-332. doi:10.1016/j.hroo.2021.06.003
10. Martin A, Coll-Vinent B, Suero C, et al. Benefits of Rhythm Control and Rate Control in Recent-onset Atrial Fibrillation: The HERMES-AF Study. Acad Emerg Med Off J Soc Acad Emerg Med. 2019;26(9):1034-1043. doi:10.1111/acem.13703
11. Lowres N, Giskes K, Hespe C, Freedman B. Reducing Stroke Risk in Atrial Fibrillation: Adherence to Guidelines Has Improved, but Patient Persistence with Anticoagulant Therapy Remains Suboptimal. Korean Circ J. 2019;49(10):883-907. doi:10.4070/kcj.2019.0234
12. Go AS, Reynolds K, Yang J, et al. Association of Burden of Atrial Fibrillation With Risk of Ischemic Stroke in Adults With Paroxysmal Atrial Fibrillation: The KP-RHYTHM Study. JAMA Cardiol. 2018;3(7):601-608. doi:10.1001/jamacardio.2018.1176
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