Empowering prevention* of Stroke related to AF

Stroke is a leading cause of disability and death, and its burden on the healthcare system is increasing with the aging of the population. Atrial fibrillation (AF) is the leading cause of cardiogenic stroke, the subtype of the disease with the highest morbidity and mortality. A test such as deCODE AF™ may improve AF detection and assist physicians in personalizing the treatment of those with AF, delivering the preventive benefits of warfarin to those who need it. It has been shown that treatment with warfarin can reduce the risk of stroke in those with AF by about 70%. (1). In fact, ACC and AHA guidelines recommend lifelong treatment for AF patients with at least one additional risk factor for stroke including history of stroke or TIA (2). However, because AF may be intermittent rather than continuous and because patients are often asymptomatic during the arrhythmia, it may go undiagnosed even following a stroke or transient ischemic attack (TIA).

Two studies have shown that an extra week of ambulatory cardiac monitoring using an automated digital event recorder following a stroke may identify AF in another 5.6 to 14.3% of stroke survivors (3, (4)). These include many who would originally be given the diagnosis of stroke of unknown etiology as well as carotid atherosclerosis-related stroke. Monitoring all ischemic stroke patients in an ambulatory setting is often considered too expensive roughly one-third of post-stroke and post-TIA patients are at hight risk for atrial fibrillation, especially when the etiology is not clear deCODE AF™ may identify patients who have intermittent AF and who are thus at high risk of recurrent stroke. Warfarin treatment of these cases may decrease the future costs of morbidity and mortality that more than outweighs the extra cost of testing and monitoring.

With the widespread current use of statins, the incidence of myocardial infarction is slowly decreasing. By contrast, the rate of stroke is increasing as a higher proportion of the population survives to the age of higher risk of stroke. It is also clear that statins have only about half the effect on stroke prevention as they do on MI prevention. Part of this may be because much of AF is not related to atherosclerosis. Therefore, we may expect the proportion of stroke due to diagnosed and undiagnosed AF to continue to increase as the atherosclerosis-related strokes are decreased by statins and anti-platelet agents. In order to effectively address AF-related strokes, a test such as deCODE AF™ may improve AF detection which can enable physicians to personalize the treatment of those with AF, delivering the benefits of warfarin to those who need it.

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