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AF complications

Undiagnosed patients are not treated with anticoagulants and therefore at increased risk for stroke.

The consequence of undiagnosed AF is that these patients do not receive treatment. This leads to an increased risk of ischemic stroke due to thrombi that may develop in the atria and especially in the atrial appendages during episodes of AF. An accepted method to quantify the risk of stroke in patients with non-rheumatic AF is based on the CHADS2 or the more recent CHA2DS2-VASc score. Determinants to calculate the CHADS2 score include the presence of Chronic heart failure, Hypertension, Age above 75, Diabetes mellitus and earlier Stroke. A high CHADS2 score corresponds to an increased risk of stroke when developing AF. The annual stroke risk for AF patients, not treated with anticoagulants is 5%, which is 2 to 7 times as high compared to non-AF patients. Treatment with vitamin-K antagonists (Coumarins) or new anticoagulants like Dabigatran (Boehringer Ingelheim), Rivaroxoban (Bayer) or Apixaban (BMS Pfizer) will reduce this risk though at the expense of increased risk of bleeding. In addition to the increased stroke risk, AF patients are at risk for developing chronic heart failure and increased mortality.

Health care cost after stroke is significant.

Stroke is a major and potentially fatal event associated with significant cost. In the United States alone, annual direct and indirect costs of care after stroke has been estimated at $73.7 Billion (AHA, Heart Disease and Stroke Statistics - 2010 Update. In the European Union (EU), Iceland, Norway, and Switzerland, 1.1 Million new stroke events occur each year and today 6 Million survivors have to live with the consequences of stroke with an annual cost exceeding €21 Billion. According to population projections in the EU, the number of new stroke events will increase to 1.5 Million per year in 2025. In more than 15% of strokes the underlying cause can be attributed to AF. It should be noted that a stroke caused by AF is more severe and has a poorer neurological outcome with more complications and higher cost. In the "Berlin Acute Stroke Study”, the short and long term (12 months) cost for medical care related to acute ischemic stroke has been investigated in patients with and without AF. In 367 patients (22% AF), with acute ischemic stroke, direct and indirect cost was analyzed. Total direct costs for ischemic stroke in patients with AF were €11,799±8,292 (mean±SD) and €8,817±7,251 in patients without AF. The highest costs were related to hospital stay (49%) and rehabilitation (16%). The mean indirect costs were respectively €3,125 and €4,513 for AF and non-AF patients. The result of this study corresponds with the results of a previous study in Germany.