Atrial Fibrillation and Dynamics of Disease Development

Introduction

Atrial fibrillation is a heart disease causing a fast, irregular heart rate. This abnormal heart rate dynamic condition might entail many dangerous side-effects to an individual’s physical condition, as the heart function is in charge of many processes undertaken in a human organism. Atrial fibrillation is the leading cause of heart failure that can lead to heart stroke and attacks. It is proven that the regular heartbeat of a healthy person equals 60 to 80 beats a minute. Valvular heart disease and high blood pressure are the main prerequisites for atrial fibrillation development, which is liable for stimulating the occurrence of concurrent sub-diseases (obesity, sleep apnea, diabetes). Nowadays, representatives of health care institutes try to devise treatment measurements to cure this disease or eliminate significant risks atrial fibrillation might impose on people’s physical well-being. Evaluating standards of practice and care disparities, health care managers can observe the dynamics of this disease development and come up with more efficient health care promotion measures.

Disease Process

Pathophysiology of Atrial Fibrillation and its Progression

AF can be defined as atrium high-frequency excitation leading to both irregular ventricular excitation and dyssynchronous atrial compression. Obviously, atrial fibrillation might happen due to the absence of well-known electrophysiological and structural heart dysfunctions (Staerk et al., 2017). Heart-related studies aim at detecting comorbid conditions, displaying the real cause of heart histopathological and structural alterations, forming atrial cardiomyopathy or a specific atrial fibrillation substrate.

Permanent AF is underlined by most valvar, hypertensive, and other kinds of structural abnormal heart diseases and cardiac rejections. AF of the familial case is well defined via a chromosome 10 (10q22-q24) that is supposed to be the gene liable for AF. In this case, arrhythmia might be considered to be the dominant trait of AF. The gene mutation under the influence of the α subunit in the pore-forming leads to the forming of chromosome 11, entailing this damage to atrial tissue. Referring to the atrial fibrillation pathophysiology, AF is caused by a reduction of cardiac channels in refractoriness.

The AF pathogenesis and its progression can be characterized via interactions between abnormal and dysfunctional tissue (eligible for arrhythmia maintenance) and initial triggers presenting themselves as ectopic foci located in pulmonary veins. This heart disease predisposes many cases and variations of AF, but it might be comprehended through the underlying process of vein trigger occurrence in terms of its pulmonary structure (Huether& McCance, 2016). There is a significant overlap in the progression of this disease, as pulmonary triggers can influence the AF paroxysm development in patients’ organisms. In this case, abnormal and dysfunctional cardiac tissues can form the subject of permanent AF.

Manifestation of Atrial Fibrillation

In fact, the manifestations of this cardiac rejection might be different, but body fatigue and little body agility is the most common symptom. As a rule, the majority of symptoms are relevant to the rapid and repetitive ventricular response. In case the ventricular reply is minimized or controlled, the manifestations might transpire from the lack of cardiac systole of AV synchrony. Patients suffering from AF are, as a rule, asymptomatic, displaying rapid heart rhythms and rates with no particular reason. More often, individuals with AF report such symptoms as dizziness, fatigue, dyspnea, diaphoresis. Palpitations are the primary indicator of AF as individuals manifest such hemodynamic signs as syncope, chest pain, and pulmonary edema.

Atrial fibrillation can be classified as:

• Occasional (symptoms last for a few minutes to some hours, symptoms might amplify and subside, and it is difficult to observe their dynamics);
• Persistent (this case of AF where heart rate cannot come back to normal on its own, as it requires meditational treatment or cardioversion in order to maintain or normalize a heart rhythm);
• Long-term persistent (AF that last more than one year and is viewed under doctors’ surveillance);
• Permanent (permanent AF is the reason for irregular heart function and rhythm, and it cannot be fixed or restored by doctors’ interference or medication help).

Diagnostic Procedures of Atrial Fibrillation

In order to observe the dynamics of AF, a doctor or a healthcare manager can describe how to undergo particular testing procedures to diagnose and examine A-fib and reduce and prevent further risks of disease development. These tests can be classified as:

• ECG (electrocardiogram). ECG is considered to be the easiest way of measuring the heart’s electrical function. By means of wires stuck to a naked body, a doctor can observe the rhythm of a heart. ECG is supposed to be the primary test for the evaluation of heart activity;
• Holter monitor. The Holter monitor is a kind of portable ECG gadget that a patient carries with themselves during one day. This gadget records the heart functions at the calm position of a person (at night) or during slight physical exercises (climbing the stairs);
• Blood test. This test enables a healthcare manager to detect micro components or substances that might entail A-fib.
• Event recorder. A patient carries a small device for a month. The gadget starts working when a person pushes a button to examine the way a heart acts out when a patient feels symptoms.
• Stress Test. This test is a substitute for exercise testing used to observe the heart works under the influence of strenuous or light work-outs.
• Chest X-Ray. It is used to observe the heart and lungs interact with each other.
• Echocardiogram. The test is used to get images of heart dimensions, proportions, motion, and its structure.

Standards of Practice: Historical and Current

Since ancient times, people have been complaining about irregular heart rates. Back then, doctors reckoned their minds to find a solution to resolve the cardiac issue. Due to numerous researches and experiments, doctors concluded that irregular heartbeat was a subsequence of heart disturbance. To cure this heart “malfunction,” Leonhart Fuchs discovered the first-ever digitals that were supposed to be the initial “antiarrhythmic” (the 16th century). William Withering introduced this apparatus in clinical practice for the first time.

Further, a quinine optical isomer and quinidine came into prominence in the clinical arena in 1918. Different antiarrhythmic medications and drugs (adenosine, beta-receptor blockers, ibutilide, amiodarone, disopyramide, propafenone, dovetailed) were devices in the 60s and 70s of the last century (Menichelli et al. 2021). Since that time, science has made a significant breakthrough in terms of clinical standards of AF management treatment.

Current Standards of Practice of Atrial Fibrillation

As mentioned above, Atrial Fibrillation is considered to be the most typical condition of a heart possessing the symptoms of established cardiac arrhythmia. As a lot of people are complaining about heart issues nowadays, individuals were provided with Guidance on Risk Assessment and Stroke Preventions for Atrial Fibrillation (GRASPAF). GRASPAF is supposed to be the preventive measure in the detection of AF symptoms. GRASPAF is an evaluating tool implemented a century ago, but it has been used till now to define prevailing and possible risks of AF development.

According to the latest research on AF, scientists recommend people several options to follow to stop or minimize AF sub-consequences. As the medicine market service is a burgeoning platform, where medical vendors are trying to beat their rival competitors, consumers are provided with a high range of medications and drugs to improve their heart health. Except for heart-related drug consumptions, patients use the pulsing treatment. A pulsing treatment with potential is a kind of ablation that creates electrical pulses that might positively impact AF treatment. Referring to the current findings, approximately 25% of patients find this treatment efficient and safe, but the pulsing treatment is in trials, and it needs further investigation.

Clinical Guidance

Evaluation of Risks of Bleeding and Stroke

Bleeding Risks

Before implement particular measures, a doctor or a healthcare manager has to analyze bleeding risks when:

• Realizing and detecting the starting point of the anticoagulation process in individuals suffering from AF;
• Checking up and examining people who have already had anticoagulation to assess the dynamics of these diseases.

Monitoring offer and assistance to alter bleeding risks embracing:

• Invertible reasons for anemia;
• Alcohol and nicotine consumption (that is harmful);
• Synchronous consumption of medications, such as antiplatelet and inhibitors of Serotonin uptake;
• Uncontrolled and chaotic hypertension.

The Risk of Stroke

The CHA2DS2-VASc stroke risk score is the score that helps doctors to detect the initial symptoms of stroke people have with the following:

• Cardiac flutter;
• Asymptomatic and symptomatic paroxysmal, that is the permanent symptom of atrial fibrillation;
• Catheter ablation or cardioversion causing the repetitive risk of arrhythmia.

Diagnosis

There are a lot of diagnostic measures that a practitioner must use. The first one is presenting and detecting AF symptoms and skimming the patient’s medical history. AF’s significant symptomatology embraces the following symptoms: dizziness, breathlessness, chest ache, discomfort, and stroke. Approximately 15% of individuals with AF manifest paroxysmal (palpitations of atrial fibrillation) that is the prerequisite for abnormal arterial dysfunction (the disorder of rhythm).

The diagnostic testing and examining of AF are the pulse palpation to find out the irregularity of heartbeat, which has about 90% sensitivity and accuracy of AF detection. Due to the low specificity rate (about 75%), a general practitioner must take an ECG assessment. In case ECG displays AF, the diagnosis is done and clear (Watanabe et al.2021). There are cases when AF does not manifest itself on a regular basis, as it has a paroxysmal structure. ECG cannot detect any AF symptoms in this instance, which means that an activated loop recorder might come in handy.

As a rule, individuals having AF do not have any symptoms, and the one possible way to detect AF is to undergo a screening procedure. Referring to the scientific findings, opportunistic screening for people who are advanced in years is the most effective way of providing evidence of AF occurrence.

Interventions with Rationales

Diagnosis and detection

According to the practitioners’ standpoints, a diagnostic test combined with a 12-lead ECG is recommended to confirm AF; this evaluation coupled with the pulse palpation is the initial rationale for a several-step strategy of AF prevention. Doctors and healthcare managers are strictly determined that 12-lead ECG is the mandatory procedure that has to be undergone by patients with AF (Dinshaw et al. 2021). However, all ECG devices that are outmoded or less accurate should be replaced as individuals want to be sure of any slight deviations in heart performance. It is primary and prioritized care for patients to monitor the cardiac function, so ECG devices should be clear enough to warrant the slightest alterations.

Stroke Risk

It is essential to start an AF-prevention strategy with a stroke prevention policy. To begin with, doctors have to assess “a certain risk threshold (discrimination) in its interpretation of the evidence rather than estimating a person’s risk of stroke in absolute terms” (NICE, 2021, p.28). It implies the definition of the “threshold for the CHA2DS2-VASC in terms of indicating the need for anticoagulation” (NICE, 2021, p.28). This particular threshold provides practitioners with a clear-cut picture of the heart’s sensitivity and the way it reacts and works in the human being’s relaxed position. In case there are some “malfunctions” of heart performance, it is necessary to resort to preemptive measures to prevent a stroke.

Bleeding Risk

To define the anticoagulation insignias, a doctor might use the “ORBIT bleeding risk score,” as it is believed to be the accurate and precise tool able to detect the initial signs of bleeding. Accurate and extensive knowledge and awareness of risks are guidelines in the decision-making process that are practically beneficial for healthcare managers. Resorting to ORBIT assistance is the principal practice on doctors’ behalf as it is supposed to be the best and most well-modified tool aligned with bleeding risk prevention. It is pervasively penetrated in clinical examinations.

Management Strategy

Patients with Unmanaged Disease vs. Patients with Managed AF

In comparison with managed AF, people with unmanaged diseases are at a high risk of developing other cardiac dysfunctions. They manifest abnormal heart rate, the absence of body agility, and high blood pressure. They continue to take prescribed medications and perform medical examinations regularly to monitor heart function (Andrade et al. 2021). When it comes to patients with the managed disease, their life practically returns back on track, and they are able to minimize all risks and normalize the heart performance. While addressing the disease, patients have to undergo the followings therapies to prolong their life expectancy considering different outcomes:

• The therapy of oral anticoagulation;
• The therapy of rate control;
• The therapy of rhythm control to normalize the sinus rhythm.

Desired outcomes of AF treatment:

• Refine the adherence to long-lasting therapy;
• Minimize hospitalization;
• Minimize mortality;
• Tailor healthcare management strategy to patients’ needs.

Factors Contributing to Patients’ Management Strategy:

• The person’s awareness of their heart condition and performance, enabling them to counsel a practitioner on time; timely checks are the best solution to monitor people’s health;
• Regular medical check-ups for improving AF, that might help individuals with AF take preemtive measures, in case the testing results depict deviations in a person’s organism;
• Governmental and social policies making people be alerted concerning their health, that might stimulate people to reassess their attitude towards their health, and not to treat it in a vigilant way.

Care Disparities

The US is supposed to be the nation that tries to accomplish breakthroughs in every single sphere; the healthcare industry is not the exception to the rules. Each state follows a strict plan that was established by the overall governmental policies. Privat or not-for-profit medical bodies try to cater to their patients, providing them with qualified healthcare services. The US medical industry has come up with innovative measures to prolong people’s heart well-being. Every state has a particular medical center, where patients can have diverse consultations in terms of monitoring their heart condition. All centers are well-equipped with modernized and modified devices and gadgets to detect cardiac issues and eliminate them. There are no particular care disparities concerning AF treatment within my community and national practices. Approximately 3 million Americans are diagnosed with AF, the treatment of these diseases requires a lot of money to invest. AF is supposed to be an economic trap and burden of the US healthcare system, as AF managements need approximately $7 billion.

AF affects the population in the USA, as individuals are at a high risk of dying in the early years. Due to diverse environmental issues, poor nutrition, and few work-outs, people aged 20 something are diagnosed with AF. Evidently, AF manifestation needs regular examinations of a person’s heart functions as a patient can get a stroke. AF treatments imply a lot of money to invest in healing these diseases. Still, it is unprofitable for Americans to get ill, as the majority of them do not have medical insurance.

Health Promotion

Resorting to collecting data research, health care organizations try to implement different techniques and methods to help people prevent heart issues or improve their condition. Patients are assured to implant a pacemaker to monitor their heart rate. This method enables individuals to take the preemptive measure as soon as possible to hinder the development of AF. Being a member of healthcare organizations, managers and representatives have to hold educational sessions to stress what side-effects people might obtain if there is non-compliance with the prescriptions.

The governmental management strategy has to be centered around enlightening patience with AF in terms of persuading them to lead a healthy lifestyle. Many sports facilities have to be provided by health care organizations and have to be accessible for people considering the high insurance price. During the other examination, a practitioner has to counsel their patients and prescribe a particular plan to follow, such as alcohol/nicotine consumption reduction, regular but slight work-outs, and a healthy diet.

It is essential to overview all possible complementary and alternative treatments for AF. Complementary treatment includes the following:

• Acupuncture;
• Yoga;
• Biofeedback;
• Herbal nutrition;
• Omega-3 acid consumption.

It is crucial to persuade patients to change their lifestyles drastically. A doctor is in charge of recommending a person with AF to lead a healthy lifestyle, such as diet change, heart strength improvement, blood pressure control, and management of the level of cholesterol.

Conclusion

Atrial Fibrillation is a common disease among human beings globally. The cardiac dysfunction performance affects people’s lives negatively, as their lives are full of regular health examinations seeing their practitioners. Suffering from AF means being on the edge of death as AF facilitates the development of stroke, heart attack, and bleeding. About 3 million people try to combat this disease by attending doctors, prescribing particular medications, ECG evaluations, and pacemaker implantation. Due to diverse variations of AF treatment, there are a lot of management strategies, and health care managers put in their best to satisfy their patients’ needs and cater to them with good service. The main aim of the health care management model is to minimize mortality and cut down the number of patients having AF.

References:

Andrade, J. G., Wells, G. A., Deyell, M. W., Bennett, M., Essebag, V., Champagne, J.,… & Verma, A. (2021). Cryoablation or drug therapy for initial treatment of atrial fibrillation. New England Journal of Medicine, 384(4), 305-315.

Dinshaw, L., Münkler, P., Schäffer, B., Klatt, N., Jungen, C., Dickow, J.,… & Meyer, C. (2021). Ablation of atrial fibrillation in patients with hypertrophic cardiomyopathy: treatment strategy, characteristics of consecutive atrial tachycardia and long‐term outcome. Journal of the American Heart Association, 10(3), 15-20.

Huether, S., L McCance. (2016). Understanding Pathophysiology, 6^th edition, Elsevier.

Menichelli, D., Vicario, T., Ameri, P., Toma, M., Violi, F., Pignatelli, P., & Pastori, D. (2021). Cancer and atrial fibrillation: Epidemiology, mechanisms, and anticoagulation treatment. Progress in Cardiovascular Diseases, 5(7), 1-9.

NICE Guideline. (2021). Atrial Fibrillation: Diagnosis and Management. Royal College of Physicians.

Staerk, L., Sherer, J. A., Ko, D., Benjamin, E. J., & Helm, R. H. (2017). Atrial fibrillation: epidemiology, pathophysiology, and clinical outcomes. Circulation research, 120(9), 1501-1517.

Watanabe, R., Nagashima, K., Wakamatsu, Y., Otsuka, N., Yokoyama, K., Matsumoto, N.,… & AF Ablation Frontier Registry Investigators. (2021). Different determinants of the recurrence of atrial fibrillation and adverse clinical events in the mid-term period after atrial fibrillation ablation. Circulation Journal, 30(6), 14-20.