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Medicineworld.org: Stroke predictors in black patients

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Stroke predictors in black patients




Predictors of atrial fibrillation (AF or afib) might offer physicians a better way to prevent stroke in blacks, as per a newly released study done by scientists at Wake Forest University School of Medicine.

AF is an irregular and often rapid heart rate that usually causes poor blood flow to the body, as well as symptoms of heart palpitations, shortness of breath and weakness. Despite low reported prevalence of AF a main risk factors for stroke in black patients, they suffer strokes five times more often than white patients and die from them two times more often.



Stroke predictors in black patients

That paradox might result from limitations in the methods (electrocardiograms (ECG) or self-report) used to detect AF, said Elsayed Z. Soliman, M.D., M.Sc. M.S., associate director of the Epidemiological Cardiology Research Center (EPICARE) at the School of Medicine and main author of the study.

"The limitations stem from the fact that AF is intermittent in at least 30 percent of patients, and most patients are not aware if they have AF or not," Soliman said. "Trying to detect AF using an ECG, or simply counting on patients to know if they have it, leads to under-diagnosis of the condition most of the time. Our research suggests that being proactive in predicting it appears to be a better approach".

The study appears in the current issue of Stroke, the peer-evaluated journal of the American Heart Association and American Stroke Association.

An electrocardiogram is a diagnostic tool that measures and records the electrical activity of the heart. Interpretation of an ECG report allows diagnosis of a wide range of heart conditions from minor to life threatening.

Doctors use ECGs to diagnose AF, and therefore assess the risk of stroke in different patients. However, ECG reports of AF have not been as useful for identifying black patients at high risk. While black patients suffer more ischemic strokes than white patients, their ECG results do not indicate AF as often.

For the study, scientists evaluated ECG data from the Atherosclerosis Risk in Communities (ARIC) study supported by the National Heart, Lung and Blood Institute. More than 15,000 people in North Carolina, Mississippi, Minnesota and Maryland took part in the study during the 1980s and 90s.

Scientists observed that, while ECG reports of AF were significantly less in black participants than in whites, black participants ultimately suffered more ischemic strokes. However, the analysis uncovered that ECGs on black participants revealed a higher rate of predictors of future AF than did the ECGs of the white participants. These ECG predictors of AF (P-wave terminal force, P-wave duration, P-wave area and PR duration) represent electrical activity within the upper two chambers of heart, or atria, which are the sources of blood clots that cause stroke if AF occurs. These ECG predictors of AF were strongly predictive of strokes and AF in blacks and whites, so scientists believe their existence could be considered as presence or future presence of AF.

"With the blacks having more abnormal ECG predictors of AF, as the results showed, there is a possibility that blacks might actually have a higher prevalence of AF than prior studies have picked up on," Soliman said. "Blacks may have more "intermittent" AF, the difficult type of AF to detect, which could be the reason why prior studies underestimated AF diagnosis more in blacks."

Soliman added that physicians, knowing this, should use the ECG to evaluate black patients' risk of stroke by determining if the patient has certain predictors of AF, instead of the condition itself. If so, the patients appears to be able to be treated with blood thinners as if they have AF. It is a therapy adjustment that could help prevent stroke, however further investigation into the subject is needed, he said.

"P-wave terminal force in the ECG may provide a strong independent predictor for incidence stroke and AF in clinical practice," Soliman said.

"For the doctor evaluating black patients for the risk of stroke, these results show that you cannot think AF is less common in this population," Soliman said.

Soliman said that the next step in research on this subject is to do a long-term ECG study to confirm the hypothesis that AF, particularly intermittent AF, has been under-diagnosed in blacks.

"We need further studies using long-term ECG recording 48 hours to 72 hours or event monitors to detect AF" he said. "The cost of these tests on population studies has always been an obstacle. However, with the results of this study, it appears to be worth it".


Posted by: Daniel    Source




Did you know?
Predictors of atrial fibrillation (AF or afib) might offer physicians a better way to prevent stroke in blacks, as per a newly released study done by scientists at Wake Forest University School of Medicine. AF is an irregular and often rapid heart rate that usually causes poor blood flow to the body, as well as symptoms of heart palpitations, shortness of breath and weakness. Despite low reported prevalence of AF a main risk factors for stroke in black patients, they suffer strokes five times more often than white patients and die from them two times more often.

Medicineworld.org: Stroke predictors in black patients

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