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Undetected non-valvular Atrial Fibrillation (AF) prevalent in Indians

AF is 35% related to Rheumatic Valvular Disease, 30% to degenerative valvular disease in elderly patients, 20 % to cardiomyopathy, and 20% comprises non-valvular AF

Dr. Guruprasad Sogunuru

Senior Consultant Cardiologist

Apollo Hospital, Chennai


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Dr.Kunal Jhaveri

As you know that if you talk about the atrial fibrillation, so definitely this disease is globally one of the prevalent disease having the incidence state of around 2% approximately, so what is your take on that, because still it seems that it is one of the under detected disease and you must have seen many patients with atrial fibrillation during your practice and during your clinical experience. So what is your take on that, what is the diagnosis rate, is that whether it is appropriate or it is underdeteted and how we can improve on this particular part as well.


Dr. Guru Prasad

Sure, the global prevalence of atrial fibrillation has been as you know, at least we have the data from U.S. and Europe, it is 2% they say and though we are large population in India but we do not have specific incidence and prevalence of atrial fibrillation but I must say now we have some West Burningham Cooperative Registry Data which says that (01


Dr.Kunal Jhaveri

So, sir as you mentioned very well that definitely in India the rheumatic condition is one of the prevalent condition from childhood and the patients are getting valvular deformity at later age on. So currently what we have also seen that there are so many screening studies are also going to happen in the Western part of the world so that they can detect the AF patient, whether it is non-valvular, because in Western Part definitely non-valvular is more prevalent (03


Dr. Guru Prasad

Certainly, because I just say one group, I am a visitor professor to Kathmandu University. I take the country of Nepal. It is a small country where we can have the true data and probably we can extra pull it the same data because it is almost neighbouring country to India. In our study, probably first study in that part of the world, may be it is equally true that in Indian statistics as well, so what we found in our study was (04


Dr.Kunal Jhaveri

It is definitely, it is very well said and even though guidelines are also now suggesting that as the term is opportunistic screening when a patient having age of something like more than 65 years then at least, what you say that at least the basic palpation method and ECG should be the part of your diagnosis, then apart from other cardiovascular disease, if patients have atrial fibrillation without any symptoms then definitely it can be detected at that time and treatment can be started as soon as possible.


Dr. Guru Prasad

Still ECG is an indispensable tool.


Dr.Kunal Jhaveri

No doubt about that surely. So definitely. Now sir if we go about the management part, as we know that in AF rate, rhythm control and apart from that the prevention of complication is also very important. Like a stroke prevention, atrial fibrillation. So since almost 1950s the VKA and the older oral anticoagulants what we can say they are available and still there are the goal standard treatment but now since almost (09


Dr. Guru Prasad

Because especially after 60 years you know the European database or registry say that after 60 years the prevalence rates of A Fib is high and especially may be even in India after 40 years I can say based on life expectancy and we all know that you know any patient with atrial fibrillation has four to five fold increased risk of stroke. So definitely in a patient of ischemic or hemorrhagic stroke sometimes in relation to atrial fibrillation is definitely under (10


Dr.Kunal Jhaveri

So definitely sir, during your discussion what you have mentioned, one point is very correct regarding the compliance issue. As you know, when the patient has atrial fibrillation (14


Dr. Guru Prasad

Certainly you know, Noax they have proven, they have established at least in treating the non-valvular atrial fibrillation at least they have proven, they have established their role and stand in treating this. I must say, because you know all of them they are compared to warfarin. It is not head-to-head comparison and warfarin comparison, they compared, so all the three drugs that is dabigatran which is direct thrombin inhibitor and the factor 10 inhibitors apixaban and rivaroxaban, (16


Dr.Kunal Jhaveri

So as you mentioned that there is no as of now head-to-head trials available, so it is very difficult to judge anybody that who is superior and who is (18


Dr. Guru Prasad

This is very important question and the situations where we face day-to-day in treating patients you know we not only treat atrial fibrillation it is not just atrial fibrillation what we need to treat, it is a complex patient in a complex situation in a clinical scenario, real world scenario. So that is where we need to face lot of challenges because the trials screen only nice patients for the inclusion criteria and exclude at least initially for the safety data, but in real world (20


Dr.Kunal Jhaveri

Yeah obviously, because So definitely sir, lastly what we have discussed regarding the atrial fibrillation its screening issues and VKA and Noax is beneficial but they have also some own concern regarding the ACS and atrial fibrillation part. So if from your side if I want to summarize this discussion in just five bullet points then how you will you put it from your side?


Dr. Guru Prasad

So there is no doubt that atrial fibrillation needs these massive bullets and definitely they are going to be prescribed in more lot and lot in future. I can summarize (25


Dr.Kunal Jhaveri

So sir definitely we are very grateful for all your thoughts and your own opinions and your discussion part, it is very helpful for us and we can take this suggestion to increase the awareness regarding atrial fibrillation, its management and the screening part as well to further medical fraternity as well. So Dr. Guru Prasad, it is very very thankful to you and it is my pleasure that you have come



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