Another risk related to atrial fibrillation

Q. My mother has atrial fibrillation. She takes a blood thinner to prevent stroke, but are there other risks she should know about?

A. Atrial fibrillation (also known as afib) is a common disorder marked by a rapid, irregular heart rhythm that causes blood to pool in the heart's upper chambers, or atria. The stagnant blood can form clots, which may then travel to the brain and cause a stroke. That's why people with afib take blood thinners, which don't actually "thin" the blood but rather discourage clot formation. While doctors have long warned about the heightened risk of stroke with afib, a recent study found that heart failure — when the heart fails to pump adequate amounts of blood to the body — might be a risk that occurs even more often.

For the study, researchers evaluated the health information of 3.5 million people ages 45 to 95 over a 23-year period. Among those who developed afib, heart failure was by far the most common complication. The lifetime risk of heart failure was two out of every five people — more than twice as likely as the risk of stroke, which occurred in about one in five people. The connection between afib and heart failure isn't entirely clear, but researchers suspect that the erratic and ineffective beating of the atria forces the lower chambers (ventricles) to work harder. Over time, that may take a toll on the heart's pumping ability.

It's yet another reason people with afib should take steps to prevent the progression of their condition, as detailed in our April 2024 issue ("Update on atrial fibrillation"). But your mother should also be vigilant about the early warning signs of heart failure, which can be subtle and easy to miss. People often attribute feeling tired or a little winded to being out of shape or growing older, but these symptoms may signal a decline in the heart's pumping ability. The classic warning signs for heart failure include the following, which go by the acronym FACES:

F: Fatigue. A weakened heart can't deliver enough oxygen-rich blood to meet the body's needs, causing a general sense of feeling tired or fatigued.

A: Activity limitation. Because people with heart failure tire easily, they often struggle to do everyday activities such as making a meal or taking a short walk.

C: Congestion. The heart's poor pumping ability causes blood to back up and fluid to leak into the lungs, which can trigger coughing and wheezing.

E: Edema or ankle swelling. Excess fluid can also collect in the ankles, legs, thighs, and abdomen, which may cause rapid weight gain.

S: Shortness of breath. Lung congestion makes breathing difficult — a problem that's often worse when the person lies down, because excess fluid from the lower body moves up toward the lungs.

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