New Atrial Fibrillation Devices Still Need Heart Healthy Compounding for Optimum Success
Atrial fibrillation (AFib) feels like the flutter of butterfly wings, patients say when asked to describe the sensation they feel in their chests. It sounds innocuous, but AFib is actually a serious heart condition that affects millions of Americans. The flutter patients describe is an irregular heartbeat, and is thought to be the starting point for stroke, blood clots, and even dementia. Medications for lowering risk of stroke are crucial, but for a number of reasons, patient compliance is unreasonably low. Recently, medical devices to reduce the risk of embolism caused by AFib have been touted in the news. The devices, or others in the constant R&D pipeline, may be effective, but heart healthy compounding remains a mainstay of effective treatment. There is no one device or medicine that will easily cure patients with AFib, and pharmacists must caution their patients not to expect too much too soon from a procedure that has yet to be proven safe.
What Is AFib and Why Is Patient Compliance with Heart Healthy Compounding Low?
Atrial fibrillation is the most common type of fibrillation and refers to an irregularity in the rate and/or rhythm of the heartbeat. More specifically, when the heart’s two upper chambers, the atria, communicate poorly through electrical signals, these chambers don’t work well with the heart’s lower chambers, the ventricula. The result is less than optimal blood flow through the body.
Irregular heart rates can be fast, slow, or have a mixed pattern and not all irregularities are a cause for concern. Patients suffering from any of these fibrillations will feel like their hearts are beating too fast or too hard. They may also experience shortness of breath, fatigue, weakness, and in some cases, chest pain.
Typically, AFib can be placed in one of three categories1:
- Occasional or paroxysmal—symptoms can be mild or severe, will come and go, and resolve on their own;
- Persistent—symptoms will persist for as long as a week and will likely need treatment to restore regular heart rhythm;
- Permanent—symptoms cannot be cured but can be managed with the right regimen of medications.
In general, AFIB treatment focuses on resetting the heart rhythm, controlling heart rate, and most importantly, preventing blood clots. The strategy can depend on the patient’s type of AFib, health profile, and other factors. Common medications include:
- Blood thinners, such as warfarin;
- Heart rhythm controllers;
- Digoxin for heart rate control;
- Beta blockers; and
- Calcium channel blockers.
These medications have serious side effects that leave patients fatigued and necessitate changes in diets and lifestyle. Many patients take themselves off the medications once their immediate symptoms disappear2 . Other patients grow tired of the complex regimen. Heart healthy compounding can include nutritional supplements to help with fatigue and can be customized to work with a patient’s other medications to simplify her regimen. Controlling heart rate and rhythm is life-saving, but compounded medications also reduce the risk of stroke and blood clots, which are just as important.
Are Medical Devices a Better Solution for Patients?
The answer is that it’s too soon to tell. Medical device companies have been looking for devices that optimize heart health, and some, such as pacemakers and ventricular defibrillators, have had a great amount of success.
Low patient compliance, even with heart healthy compounding, has driven many to look for a more permanent solution, and researchers at Boston Scientific say they have found that solution. They are referring to the new Watchman device recently approved by the FDA3 to filter out clots before they reach the heart. The company says patients can come off stroke medications within 45 days.4 Another device, the Lariat, is also in development, along with devices further down in the pipeline.5
It is widely thought that clots in patients with AFib come from the left atrial appendage. Both the Watchman and the Lariat are implanted devices that close this appendage off from the rest of the heart, blocking the route for potential clots to travel to the brain.
Both show a good deal of promise but deployment of the devices is still in an early stage and no one knows yet what the long-term success of these devices will be. Current AFib guidelines do not recommend the surgery, but also do not discourage it either, especially in patients who cannot take blood thinners.6
What Can Pharmacists Tell Patients to Expect?
Patients are primed to expect life-changing cures and devices that will solve all of their problems, but it’s too early to tell them that the latest crop of AFib devices will allow them to give up their medications entirely. As part of the patient’s healthcare team, pharmacists should encourage their patients to consider the risks and rewards of the different treatments that are available. Issues to consider include:
- Is the patient an ideal candidate for the device and procedure? The Watchman offers the largest patient dataset but overall, both it and the Lariat are relatively new to the market.
- Any surgical procedure will require pain medication, both in the short and long terms. How does this impact patient decision?
- What should patients expect in transitioning off blood thinners, and other medications? What should they look for in terms of symptoms for unexpected cardiac events?
- What does the patient consider the best quality of life, and how will this device help or hinder in achieving that lifestyle? How do her current medications fit in the big picture?
It would be great to find all encompassing solutions for the many diseases that affect our patients. It’s good to hope, but it’s necessary to understand the reality of new devices and new drugs, and how to incorporate them safely into your health care. Pharmacists can and should be part of that real solution.
At Pharmaceutica North America, we are excited that new research leads to new treatments options. Patients are best served when they are aware of all their options, and can trust their pharmacists to help them understand those options. When medication is part of those options, we can provide you with safe and high-quality compounding materials. Let us help you give your patients the care they deserve. Contact us today.
- “Diseases and Conditions: Atrial fibrillation,” http://www.mayoclinic.org/diseases-conditions/atrial-fibrillation/basics/symptoms/con-20027014 ↩
- ”Atrial Fibrillation Medicines, April 16, 2014, http://www.heart.org/HEARTORG/Conditions/Arrhythmia/AboutArrhythmia/Atrial-Fibrillation-Medications_UCM_423781_Article.jsp ↩
- “FDA Approves Boston Scientific’s Watchman Device,” July 8, 2015, http://www.wsj.com/articles/fda-approves-boston-scientifics-watchman-device-1426358505 ↩
- “New device may help treat atrial fibrillation,” August 8, 2015, http://www.king5.com/story/news/health/body/2015/08/05/new-device-may-help-treat-atrial-fibrillation/31194565/ ↩
- “A New Device Allows Atrial Fibrillation Patients to Get Off Blood Thinners,” April 14, 2015, http://www.everydayhealth.com/columns/health-answers/new-device-allows-atrial-fibrillation-patients-get-off-blood-thinners/ ↩
- “Left Atrial Appendage Closure: Resist the Urge?,” March 20, 2015, http://www.medscape.com/viewarticle/841773 ↩