A first-of-its-kind community health survey and screening conducted in Thiruvananthapuram district, among 50,000 adults over a period of two years, has reported an alarming proportion of Atrial fibrillation (A-fib) and heart failure (HF) amongst the population.
A-fib or irregular heart rhythm can lead to life-threatening complications like stroke and heart failure, while the latter is a chronic, debilitating condition which can lead to sudden cardiac death or long-term organ damage.
Among the highest rates
The proportion of the study population with A-fib was found to be 0.9%. The proportion of HF in Thiruvananthapuram was 1.69% and is one of the highest reported prevalence rates for heart failure in the country, Sunitha Viswanathan, Professor and Head of the Department of Cardiology, Government Medical College, Thiruvananthapuram, who led the study, told The Hindu.
The study, conducted from April 2019 to April 30, 2022, was a joint initiative of the Department of Cardiology of the medical college and the Kerala Heart Foundation.
Major implications
The findings of the study has huge public health implications for Kerala as A-fib and Heart Failure are the direct consequences of lifestyle diseases or risk factors like uncontrolled hypertension, diabetes, metabolic syndrome or coronary artery diseases. Latest reports put the diabetes prevalence in Kerala at 24% and that of hypertension at a whopping 40%.
Given the fact that A-fib and HF are associated with multiple adverse comorbidities that can contribute to significant mortality and morbidity, including stroke and dementia, urgent interventions are required for the early diagnosis and treatment of these conditions in the community, Dr. Viswanathan said.
While population-wide screening for A-fib and HF might not be a practical proposition, it can be incorporated as a component in the State’s non communicable diseases control programme. Physicians manning the NCD clinics in primary/family health centres can be trained to recognise symptoms and diagnose the condition, so that treatment can be initiated early to prevent complications, she added.
Treatment is expensive and often life-long and hence will have to be offered as part of the NCD Control programme. Even after diagnosis, less than 20% of the people with heart failure gets proper guideline-directed medical therapy.
A-fib, which causes life-threatening complications, is often silent and its discovery is often incidental, when the patient is probably hospitalised following a stroke.
Survey methods
The survey was done in a manner that left no room for ambiguities. A core team of ASHAs underwent continuous training to administer a smartphone-based questionnaire. They were taught to explain to people the importance of the survey. The survey teams used AliveCor Kardia ECG monitor, a smartphone-based one-lead ECG recording, for the detection of atrial fibrillation. The ECG readings were transferred to a central server and evaluated real-time by a group of physicians.
Warning signs
All persons identified with A-fib or HF were evaluated by a team of cardiologists at medical camps. Some 90 such camps were organised by the cardiology department in the community where detailed patient history, physical examination, transthoracic echo, 12 lead EKG and serum NT proBNP, a blood marker test to identify cases where heart failure was suspected despite normal pumping.
Smoking, alcohol abuse, thyroid diseases, obesity and obstructive sleep apnea were more in A-fib patients, highlighting the need for healthy heart lifestyles. Targeted screening of at-risk individuals can help identify those with A-fib or heart failure early. Initiating treatment using anticoagulants early can help prevent many devastating strokes, it is pointed out.
