Knowledge Gaps And Misperceptions On Impact of Atrial Fibrillation And Stroke Exist Among Patients, Caregivers, And Physicians

BOSTON – A white paper published today by the Heart Rhythm Society (HRS) and National Stroke Association characterizes the impact of stroke on patients with atrial fibrillation (AF) and presents common barriers to effective communication among patients, caregivers, and physicians. The white paper,Impact of Stroke in Atrial Fibrillation, is a collaborative effort between the two organizations to improve education and diminish stroke risk in patients with AF. The results of the white paper are based on a survey administered to AF patients with and without history of stroke, caregivers of stroke survivors and physicians across a range of specialties and collectively included more than 1,200 respondents. The survey administration was funded by Boehringer Ingelheim and administered by Russell Research, an independent research firm.

HRS and National Stroke Association appointed a working group with relevant expertise, consisting of two electrophysiologists and two vascular neurologists, to design the survey questions and analyze the results once captured. Following analysis of the results, the group was able to identify significant knowledge gaps among patients, caregivers and physicians in relation to AF and stroke.

The white paper includes detailed results from the survey and presents principal findings in the following areas:

  • Gaps in patient and physician knowledge
  • Underestimation of the impact of stroke in AF
  • Gaps in perspective between patients and physicians
  • Opportunities to improve knowledge, communication and outcomes

The white paper shows that critical gaps in knowledge were identified among AF patients. The results reveal that AF patients underestimate the devastating impact of stroke on their lives and those of their caregivers. AF patients were more motivated to learn about preventing stroke and comply with prescribed antithrombotic therapy than physicians realized.

“Not only did we identify some important barriers to effective communication, but also barriers to the appropriate use of anticoagulation from the perspectives of patients and physicians,” said Philip Gorelick, MD, National Stroke Association board member and member of the working group. “By analyzing these different population groups, we were able to pinpoint exactly where and when the gaps were occurring, allowing us to now offer recommendations for improvement.”

The working group provides specific recommendations on how patients, caregivers, and physicians can decrease knowledge gaps and diminish the risk of AF-related stroke, which include the following:

Group Recommendation
  • Learn common symptoms of stroke
  • Understand negative impact of stroke on quality of life
  • Learn how AF can increase stroke risk; how oral anticoagulants reduce risk
  • Convey desire for knowledge and willingness to follow recommendations
  • Attend physician visits with AF patients and ask about reducing stroke risk
  • Encourage AF patients to comply with prescribed treatment
  • Know and comply with treatment recommendations from guidelines
  • Understand patients are motivated to reduce risk; usually compliant with prescribed treatments
  • Obtain high quality written materials to educate patients and caregivers
  • Establish infrastructure for managing anticoagulation to diminish barriers to prescribing vitamin K antagonists
  • Increase public awareness through participation in educational campaigns

“Providing better education and communicating more effectively with our patients are essential to not only decreasing the impact of stroke in patients but potentially preventing it,” said David Frankel, MD, FHRS, Assistant Professor of Medicine at the Hospital of University of Pennsylvania and chair of the working group. “Our working group feels confident that the recommendations we have provided will help patients, caregivers and physicians take positive steps forward and ultimately improve overall outcomes in patient care.” 

AF is the most common heart arrhythmia affecting an estimated3 million people in the United States[i] and an estimated 33.5 million people worldwide[ii]. AF patients are five times more likely to have a stroke than people without AF[iii]. Oral anticoagulants significantly reduce the risk of ischemic strokes[iv]; however, remain underutilized in patients with AF who are at an increased risk for stroke[v].

The white paper was published in the online version of HeartRhythm, the official journal of HRS, on May 13 and in the National Stroke Association’sJournal of Stroke and Cerebrovascular Diseaseson [XX].

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[i] Naccarelli GV, Varker H, Lin J, Schulman KL. Increasing prevalence of atrial fibrillation and flutter in the United States. Am J CardiolDec 1 2009;104:1534-1539.

[ii] Chugh SS, Havmoeller R, Narayanan K, et al. Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study. CirculationFeb 25 2014;129:837-847.

[iii] [iii] Wolf P A, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke. 1991;22:983-988.

[iv] van Walraven C, Hart RG, Singer DE, Laupacis A, Connolly S, Petersen P, Koudstaal PJ, Chang Y, Hellemons B. Oral anticoagulants vs aspirin in nonvalvular atrial fibrillation: an individual patient meta-analysis. JamaNov 20 2002;288:2441-2448.

[v] Ogilvie IM, Newton N, Welner SA, Cowell W, Lip GY. Underuse of oral anticoagulants in atrial fibrillation: a systematic review. Am J MedJul 2010;123:638-645 e634.

About the Heart Rhythm Society

The Heart Rhythm Society is the international leader in science, education and advocacy for cardiac arrhythmia professionals and patients, and the primary information resource on heart rhythm disorders. Its mission is to improve the care of patients by promoting research, education and optimal health care policies and standards. Incorporated in 1979 and based in Washington, DC, it has a membership of more than 5,800 heart rhythm professionals in more than 72 countries around the world. For more information, visit

About National Stroke Association

National Stroke Association is the only national organization in the U.S. that focuses 100 percent of its efforts on stroke by developing compelling education and programs focused on prevention, treatment, rehabilitation and support for all impacted by stroke. Founded in 1984, the organization works every day to meet its mission to reduce the incidence and impact of stroke. Visit to learn more.