Feature | May 14, 2015

Heart Rhythm Society Explores Misperceptions Associated With Atrial Fibrillation

Joint HRS/National Stroke Association publication outlines specific recommendations for improving communication and education

HRS, National Stroke Association, atrial fibrillation, AF, misperceptions, paper

May 14, 2015 — A white paper published 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 paper is based on the results of a survey administered to AF patients with and without history of stroke, caregivers of stroke survivors, and physicians across a range of specialties. The survey collected more than 1,200 respondents; 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, M.D., 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:


  • 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, M.D., 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 estimated 3 million people in the United States and an estimated 33.5 million people worldwide. AF patients are five times more likely to have a stroke than people without AF. Oral anticoagulants can significantly reduce the risk of ischemic strokes; however, remain underutilized in patients with AF who are at an increased risk for stroke.

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’s Journal of Stroke and Cerebrovascular Diseases.

For more information: www.hrsonline.org, www.stroke.org

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