tag:theconversation.com,2011:/nz/topics/atrial-fibrillation-26395/articlesAtrial fibrillation – The Conversation2023-07-20T08:03:37Ztag:theconversation.com,2011:article/2082022023-07-20T08:03:37Z2023-07-20T08:03:37ZWhat is atrial fibrillation, the heart condition US President Joe Biden lives with?<p>US President Joe Biden <a href="https://www.whitehouse.gov/wp-content/uploads/2023/02/Health-Summary-2.16.pdf">has</a> the heart condition atrial fibrillation. This increases his risk of having a stroke <a href="https://www.stroke.org.uk/what-is-stroke/are-you-at-risk-of-stroke/atrial-fibrillation">five-fold</a> and <a href="https://academic.oup.com/eurheartj/article/42/5/373/5899003?login=false">doubles</a> the risk of a heart attack or dementia.</p>
<p>More than <a href="https://journals.sagepub.com/doi/full/10.1177/1747493019897870?casa_token=xNrhAk_qBIQAAAAA%3A2DRaB1b1avVWKJFlBsKmEgRYXienljZDL4qhdajIGcOp4F4MwX9r_77vySuqdNS7pzHbY9RiZXuwkpw">37.5 million</a> people globally also have atrial fibrillation, but many don’t realise they have it. </p>
<p>For most, the condition has few symptoms and does not limit daily life. However, identifying it and treating it is the only way to reduce its serious health consequences.</p>
<p>Our research, <a href="https://heart.bmj.com/content/early/2023/07/03/heartjnl-2023-322602">just published</a> in the journal Heart, looks at the importance of managing blood pressure in reducing such risks.</p>
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Read more:
<a href="https://theconversation.com/health-check-what-do-my-blood-pressure-numbers-mean-29212">Health Check: what do my blood pressure numbers mean?</a>
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<h2>What is atrial fibrillation?</h2>
<p>Atrial fibrillation is when the heart <a href="https://www.heartfoundation.org.au/bundles/your-heart/atrial-fibrillation">beats irregularly</a>, sometimes fast, sometimes slow. It’s the <a href="https://journals.sagepub.com/doi/full/10.1177/1747493019897870?casa_token=xNrhAk_qBIQAAAAA%3A2DRaB1b1avVWKJFlBsKmEgRYXienljZDL4qhdajIGcOp4F4MwX9r_77vySuqdNS7pzHbY9RiZXuwkpw">most common</a> heart rhythm disorder and is more common as you get older. But some people develop it in their 30s and 40s.</p>
<p>The abnormal heart rhythm starts in the top chambers of the heart, meaning the heart does not propel the blood forward properly. This, and the erratic movements of these heart chambers, result in blood pooling, and occasionally clots.</p>
<p>The heart can go into atrial fibrillation for short periods of time, and then return to normal rhythm, or stay in this abnormal heart rhythm continuously.</p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/UOkseyF-wrA?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Here’s what happens if you have atrial fibrillation and your heart beats irregularly.</span></figcaption>
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<h2>How do I know if I have it?</h2>
<p>Some people have lots of symptoms, such as heart palpitations (a feeling of fluttering or pounding heart), breathlessness or even discomfort, and know exactly when they have gone into atrial fibrillation. Their symptoms can stop what they would normally do. But others have no symptoms and don’t know they have atrial fibrillation. We know very little about why some people have symptoms and others do not.</p>
<p>If you have symptoms, discuss these <a href="https://academic.oup.com/eurheartj/article/42/5/373/5899003?login=false">with your GP</a>. Your GP will ask about triggers for your symptoms, your general health and other risk factors, and will likely organise an <a href="https://www.heartfoundation.org.au/bundles/your-heart/medical-tests-for-heart-disease">electrocardiogram</a> (also called an ECG). This is a type of non-invasive test where 12 leads are attached to your chest to measure the electrical activity of the heart.</p>
<p>Generally, your GP will refer you to a cardiologist (heart specialist) or a hospital clinic if they suspect you have a heart rhythm problem, including atrial fibrillation, for further testing and treatment.</p>
<p>Some people say you can detect atrial fibrillation using <a href="https://theconversation.com/should-you-really-use-your-smartwatch-or-fitness-wearable-to-monitor-your-heart-194060">consumer wearables</a>, such as smartwatches. However, it’s not clear how accurate these are.</p>
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<a href="https://images.theconversation.com/files/536191/original/file-20230707-25-yl4bur.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Health worker with ECG trace in hand, man lying on hospital bed in background" src="https://images.theconversation.com/files/536191/original/file-20230707-25-yl4bur.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/536191/original/file-20230707-25-yl4bur.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=403&fit=crop&dpr=1 600w, https://images.theconversation.com/files/536191/original/file-20230707-25-yl4bur.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=403&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/536191/original/file-20230707-25-yl4bur.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=403&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/536191/original/file-20230707-25-yl4bur.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=507&fit=crop&dpr=1 754w, https://images.theconversation.com/files/536191/original/file-20230707-25-yl4bur.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=507&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/536191/original/file-20230707-25-yl4bur.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=507&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">An ECG measures the electrical activity of your heart.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/electrocardiogram-ecg-hand-clinic-cardiology-heart-566691763">Shutterstock</a></span>
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Read more:
<a href="https://theconversation.com/is-this-love-or-an-arrhythmia-your-heart-really-can-skip-a-beat-when-youre-in-love-176537">Is this love ... or an arrhythmia? Your heart really can skip a beat when you're in love</a>
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<h2>What happens after you’re diagnosed?</h2>
<p>Once diagnosed with atrial fibrillation, you will be assessed for serious potential complications, such as an increased risk of stroke.</p>
<p>You’ll be advised to manage any risk factors that worsen atrial fibrillation and increase your risk of stroke. This includes cutting down on alcohol, managing your weight and doing more exercise.</p>
<p>Some people at higher risk of a stroke will be started on blood thinning medicines. Some people may also need to take medicines to control their heart rhythm or have a procedure called “ablation”. This is when wires are passed into the heart to identify and treat the electrical origin of the condition.</p>
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Read more:
<a href="https://theconversation.com/what-should-my-heart-rate-be-and-what-affects-it-98945">What should my heart rate be and what affects it?</a>
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<h2>How about high blood pressure?</h2>
<p>More than <a href="https://www.ahajournals.org/doi/10.1161/CIRCRESAHA.117.311402#:%7E:text=Hypertension%20ultimately%20increases%20the%20risk,%25%20to%2080%25%20of%20individuals">three in five</a> people with atrial fibrillation also have high blood pressure (hypertension). This is another major cause of stroke and heart attack. So managing blood pressure is very important.</p>
<p>In our <a href="https://heart.bmj.com/content/early/2023/07/03/heartjnl-2023-322602">new research</a>, we analysed data from the electronic medical records from about 34,000 Australian GP patients with both atrial fibrillation and hypertension. We found one-in-three had poorly controlled blood pressure. This places a group already at a high risk of stroke at an even greater risk.</p>
<p>When someone’s blood pressure is poorly controlled, this is usually because their medicines are not adequately bringing down their blood pressure. This could be because doctors are not increasing the number of different types of medicine when needed, or because patients cannot afford their medicines, or forget to take them.</p>
<p>We also found that people who visited the same GP regularly were more likely to have their blood pressure controlled, so were at lower risk of stroke.</p>
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<a href="https://images.theconversation.com/files/537245/original/file-20230713-15-lr4gwj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Female doctor checking blood pressure of older male" src="https://images.theconversation.com/files/537245/original/file-20230713-15-lr4gwj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/537245/original/file-20230713-15-lr4gwj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/537245/original/file-20230713-15-lr4gwj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/537245/original/file-20230713-15-lr4gwj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/537245/original/file-20230713-15-lr4gwj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/537245/original/file-20230713-15-lr4gwj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/537245/original/file-20230713-15-lr4gwj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Our research highlighted the importance of seeing the same GP regularly.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-woman-doctor-wearing-white-uniform-1805492158">Shutterstock</a></span>
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Read more:
<a href="https://theconversation.com/how-to-recognise-a-stroke-and-what-you-should-know-about-their-treatment-63651">How to recognise a stroke and what you should know about their treatment</a>
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<h2>Why is this important?</h2>
<p>It is important people at the highest risk of stroke – such as those with both atrial fibrillation and high blood pressure – are receiving appropriate treatment to minimise their risk.</p>
<p>Strokes, heart attacks and dementia are still leading causes <a href="https://www.aihw.gov.au/reports/life-expectancy-death/deaths-in-australia/contents/leading-causes-of-death">of death</a> and <a href="https://www.aihw.gov.au/reports/burden-of-disease/australian-burden-of-disease-study-2022/contents/summary#">ill health</a> in Australia. Prevention is so much better than treating them when they develop.</p><img src="https://counter.theconversation.com/content/208202/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ritu Trivedi is a recipient of the Commonwealth Government Research Training Program Stipend Scholarship to support her PhD studies.</span></em></p><p class="fine-print"><em><span>Clara Chow receives funding from National Health and Medical Research Council. Dr Chow is affiliated with the Cardiac Society of Australia and New Zealand. </span></em></p><p class="fine-print"><em><span>Liliana Laranjo receives funding from the National Health and Medical Research Council. </span></em></p>This common heart condition puts you at increased risk of having a stroke, especially if you also have high blood pressure. But our new research shows what you can do to lower your risk.Ritu Trivedi, PhD Student, University of SydneyClara Chow, Cardiologist at Westmead Hospital; Director of the Westmead Applied Research Centre, University of SydneyLiliana Laranjo, Senior Lecturer in Digital Health and Community and Primary Health Care Practice, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1940602022-11-08T19:40:21Z2022-11-08T19:40:21ZShould you really use your smartwatch or fitness wearable to monitor your heart?<figure><img src="https://images.theconversation.com/files/494006/original/file-20221108-22-8gdqj1.jpg?ixlib=rb-1.1.0&rect=4%2C22%2C2991%2C1976&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Dragana Gordic / Shutterstock</span></span></figcaption></figure><p>Wearable devices that can record your pulse can be handy for tracking your fitness – but can you really use them to monitor for an irregular heartbeat?</p>
<p>The short answer is maybe, and it depends on who you are. These devices are great, but there are some things you need to know.</p>
<p>Several large studies have been carried out to examine how well wearables can check for signs of a common heart rhythm problem called “atrial fibrillation”, which can lead to strokes.</p>
<p>In a <a href="https://doi.org/10.1161/CIRCULATIONAHA.121.058911">new Frontiers review published in Circulation</a>, we and our colleagues in the <a href="https://www.afscreen.org">AF-Screen International Collaboration</a> weighed up the current evidence, including from three very large studies: the <a href="https://doi.org/10.1161/CIRCULATIONAHA.122.060291">Fitbit Heart study</a> (funded by Fitbit); the <a href="https://www.nejm.org/doi/full/10.1056/nejmoa1901183">Apple Heart study</a> (supported by Apple) and the <a href="https://www.jacc.org/doi/abs/10.1016/j.jacc.2019.08.019">Huawei Heart study</a> (Huawei was involved in development and optimisation of the app but did not fund the study).</p>
<h2>What is atrial fibrillation?</h2>
<p>Atrial fibrillation is the most common heart rhythm problem (arrhythmia). Up to <a href="https://academic.oup.com/eurheartj/article/42/5/373/5899003?login=false">80% of patients may have no symptoms</a>.</p>
<p>Atrial fibrillation becomes more common with increasing age, and it can substantially increase the risk of stroke. Patients at <a href="https://www.mdcalc.com/calc/801/cha2ds2-vasc-score-atrial-fibrillation-stroke-risk">high risk</a> of atrial fibrillation-related stroke, due to age and/or other risk factors such as hypertension and diabetes, are generally prescribed blood-thinning medication.</p>
<p>More and more devices for recording heart rhythm are available to consumers. These include handheld electrocardiogram (ECG) and pulse-based technology in smartwatches, other wearables and portable consumer devices. These are often marketed as “health and wellness” products.</p>
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Read more:
<a href="https://theconversation.com/why-wearable-fitness-trackers-arent-as-useless-as-some-make-them-out-to-be-173419">Why wearable fitness trackers aren't as useless as some make them out to be</a>
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<p>For people aged 65 and over, <a href="https://www.heartfoundation.org.au/Bundles/Your-heart/Conditions/Atrial-Fibrillation-for-Professionals">Australian</a> and other international <a href="https://academic.oup.com/eurheartj/article/42/5/373/5899003?login=false">guidelines</a> <a href="https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.116.026693">recommend</a> occasional screening for atrial fibrillation.</p>
<p>However, new technologies (including wearables) allow consumers to record their own heart rhythms whenever they wish, and continuously monitor the regularity of their pulse. This technology can empower consumers and provide important information, but it does have limitations.</p>
<h2>How accurate are wearables and other consumer devices?</h2>
<p>The short answer is that, for identifying atrial fibrillation, wearables are probably quite accurate (<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8752409/">often over 95%</a>). However, the information is often based on studies of small numbers of people.</p>
<p>Some devices include an algorithm that automatically says whether your heart rhythm is regular (a “normal sinus rhythm”) or irregular (which may indicate atrial fibrillation). These algorithms generally require regulatory approval (such as from the <a href="https://www.tga.gov.au/how-we-regulate/manufacturing/medical-devices/manufacturer-guidance-specific-types-medical-devices/regulation-software-based-medical-devices">Therapeutic Goods Administration</a> (TGA) in Australia). </p>
<p>However, device companies often don’t publish many details about the accuracy and performance of their devices. Wearables that simply track heart rate or activity without making claims about serious conditions are not regulated by the TGA.</p>
<p>It’s important that manufacturers of health devices:</p>
<ul>
<li><p>are accurate in their health claims</p></li>
<li><p>don’t advertise unproven benefits</p></li>
<li><p>report the accuracy and performance of their devices in different populations.</p></li>
</ul>
<p>While the <a href="https://doi.org/10.1161/CIRCULATIONAHA.122.060291">Fitbit</a>, <a href="https://www.nejm.org/doi/full/10.1056/nejmoa1901183">Apple</a> and <a href="https://www.jacc.org/doi/abs/10.1016/j.jacc.2019.08.019">Huawei</a> studies were very large, the calculations used to determine accuracy of the device may be based on small numbers because not many people in the study had atrial fibrillation.</p>
<p>For example, the <a href="https://www.nejm.org/doi/full/10.1056/nejmoa1901183">Apple Heart study</a> had 419,000 participants overall – which is a lot of people! However, the accuracy was calculated by comparing simultaneous recordings of atrial fibrillation on the smartwatch pulse irregularity detector and an ECG patch in only 86 people.</p>
<h2>Who are they good for?</h2>
<p>If you have symptoms, or are aged over 65, wearables can be very useful for detecting atrial fibrillation.</p>
<p>Wearables are great as an “event recorder” for anyone with a symptom (such as heart palpitations) that could be an arrhythmia. Devices with ECG capability such as <a href="https://www.apple.com/au/healthcare/apple-watch/">Apple Watch</a> Series 4 or later, <a href="https://www.withings.com/au/en/scanwatch">Withings Scanwatch</a> and <a href="https://www.kardia.com/">KardiaMobile</a> are particularly good as they provide more information. Once you have an ECG recording during a symptom, you can give it to your doctor, which can help guide further follow-up.</p>
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<img alt="A photo of a smartwatch on a woman's wrist." src="https://images.theconversation.com/files/494052/original/file-20221108-16-e5ih7r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/494052/original/file-20221108-16-e5ih7r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/494052/original/file-20221108-16-e5ih7r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/494052/original/file-20221108-16-e5ih7r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/494052/original/file-20221108-16-e5ih7r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/494052/original/file-20221108-16-e5ih7r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/494052/original/file-20221108-16-e5ih7r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Wearable devices give us more heart rhythm data than ever before – but it’s not always clear how to interpret it.</span>
<span class="attribution"><span class="source">Unsplash</span></span>
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<p>Wearables are also good for helping people to get an early diagnosis of atrial fibrillation. Ideally, this needs to be supported by integrated care, including risk factor reduction and lifestyle changes to reduce progression and complications (especially relevant for young people who may need no specific therapy).</p>
<p>We also know wearables can be used to screen enormous numbers of people: 457,000 in the Fitbit study, 419,000 in the Apple Heart study and 188,000 in the Huawei study. However, the yield of <a href="https://doi.org/10.1038/s41569-022-00803-9">new atrial fibrillation detected was low</a> (less than 1%) in these studies, mainly because the study participants were very young (the average age in all three studies was 41 years or less).</p>
<h2>What are the problems then?</h2>
<p>More data isn’t always better. If your GP checks your pulse at an appointment, finds it irregular and an ECG confirms it is atrial fibrillation, it’s likely you are experiencing atrial fibrillation quite a lot of the time (or all the time).</p>
<p>The risks of atrial fibrillation are <a href="https://www.thieme-connect.com/products/ejournals/abstract/10.1055/a-1588-8867">similar</a> for people with symptoms and those without, and we know how to treat the condition.</p>
<p>However, wearables are able to monitor people’s heart rhythm far more frequently and for much longer. The more you look, the more atrial fibrillation you find, but we are not yet sure we should.</p>
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Read more:
<a href="https://theconversation.com/the-media-is-overhyping-early-detection-tests-and-this-may-be-harming-the-healthy-158229">The media is overhyping early detection tests, and this may be harming the healthy</a>
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<p>So, while wearables increase detection of atrial fibrillation, we don’t know whether this will also prevent strokes.</p>
<p>Many people who buy wearables are younger and at lower risk. We aren’t yet sure about what it means when a young person with few or no risk factors has short episodes of atrial fibrillation.</p>
<p>More evidence is needed, ideally from good-quality, independent, randomised studies.</p>
<h2>Drawbacks and data</h2>
<p>Even highly accurate devices can and do <a href="https://twitter.com/CardiologyBlurb/status/1587302634976735232">sometimes give false positives</a>, more frequently in younger people who have a lower risk of having atrial fibrillation. Additional tests may be needed, which increase cost, and may lead to unnecessary testing that could cause problems and potentially anxiety.</p>
<p>Data privacy is also a concern. There are important legal gaps in relation to <a href="https://support.mips.com.au/home/should-you-trust-the-data-from-wearable-fitness-devices">data protection and regulation of apps</a> in many countries.</p>
<p>Consumers often lack <a href="https://canberraweekly.com.au/who-owns-the-data-fitbits-and-private-health-data-give-pause-for-thought/">ownership or control of data</a> from health apps.</p>
<h2>What should I do if my wearable tells me I have atrial fibrillation?</h2>
<p>If your device says you may have atrial fibrillation, save a copy of the reading and talk to your doctor about the result. You may need further testing or treatment. However, don’t panic!</p>
<p>We need to remember one size doesn’t fit all. Either way, wearables are here to stay. We have to make sure we understand their benefits and limitations.</p><img src="https://counter.theconversation.com/content/194060/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr Jessica Orchard is a Research Fellow at the Centenary Institute and Adjunct Senior Lecturer, School of Public Health, the University of Sydney. She is supported by a Heart Foundation fellowship and some of her research has been supported by Pfizer-BMS (investigator-initiated research grants) and Alivecor (provided devices for study purposes).</span></em></p><p class="fine-print"><em><span>Ben Freedman receives current competitive grant funding from the Medical Research Future Fund, the NSW Dept of Health, and from the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation programme under the grant agreement no. 648131, the European Union’s Horizon 2020 research and innovation programme under the grant agreement no. 847770 (AFFECT-EU). In the past 5 years, B.F. has received speaker fees and travel support for speaking at sessions or official satellites of large international or continental society meetings from Bayer, Bristol-Myers Squibb–
Pfizer Alliance, Daiichi Sankyo and Omron; and investigator-initiated research grants to the institution from Bristol-Myers Squibb–Pfizer Alliance. </span></em></p>Wearables and smartwatches can track your pulse – but if you’re using them to scan for irregular heart rhythms, there are some things you should know.Jessica Orchard, Research Fellow, Centenary Institute; and Adjunct Senior Lecturer, School of Public Health, University of SydneyBen Freedman, Director External Affairs and Group Leader Heart Rhythm & Stroke Group, Heart Research Institute, and Honorary Professor, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1924822022-10-28T12:32:16Z2022-10-28T12:32:16ZFetterman’s struggles with language highlight the challenges after a stroke – a vascular neurologist explains aphasia and the path to recovery<figure><img src="https://images.theconversation.com/files/491777/original/file-20221025-4775-gi4cin.jpg?ixlib=rb-1.1.0&rect=0%2C11%2C3830%2C2562&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The stroke suffered by U.S. Senate candidate John Fetterman has shed light on little-known aspects of stroke recovery.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/democratic-candidate-for-u-s-senate-john-fetterman-reacts-news-photo/1243990171?phrase=John%20fetterman&adppopup=true">Mark Makela/Getty Images News via Getty Images</a></span></figcaption></figure><p><em>John Fetterman, the Democratic nominee for a hotly contested U.S. Senate seat in Pennsylvania, has been drawing scrutiny for his performance in his <a href="https://www.nbcnews.com/politics/2022-election/fetterman-says-stroke-recovery-changes-everything-s-fit-serve-senator-rcna51498">first post-stroke broadcast interview</a> and most recently, his Oct. 25, 2022, <a href="https://www.nytimes.com/2022/10/25/us/politics/debate-fracking-abortion-fetterman-oz.html">Senate debate against Republican Mehmet Oz</a>.</em></p>
<p><em>Fetterman suffered a stroke on the way to a campaign event in May 2022. His apparent post-stroke neurological effects - including auditory processing and speech issues – have caused some to <a href="https://www.cnn.com/2022/10/26/politics/john-fetterman-oz-debate-pa-senate-stroke/index.html">question his fitness for the role</a> and have become a <a href="https://www.newyorker.com/news/daily-comment/what-voters-can-and-cant-learn-from-john-fettermans-stroke">central factor in the Senate race</a>. The Conversation asked Andrew Southerland, <a href="https://uvahealth.com/findadoctor/profile/andrew-m-southerland">a vascular neurologist</a> specializing in stroke and cerebrovascular disease who sees many patients like Fetterman, to explain what Fetterman’s case can teach us about stroke recovery.</em></p>
<h2>What does the public know about Fetterman’s stroke?</h2>
<p>Fetterman has chosen not to release his full medical record, so it’s not possible to draw conclusions about the exact location or extent of brain injury resulting from his stroke. He and his team have confirmed that his initial symptoms began with feeling fatigued and slurring his speech, which his wife immediately identified as a possible stroke. </p>
<p>Because of her early recognition of his symptoms and rapid transport to a nearby facility, Lancaster General Hospital in Pennsylvania, he had the opportunity to receive a clot-busting drug called a <a href="https://www.pennmedicine.org/for-patients-and-visitors/find-a-program-or-service/heart-and-vascular/vascular-surgery-and-endovascular-therapy/vascular-procedures/thrombolysis#">thrombolytic</a> and underwent a catheter-based procedure to remove the blood clot from an artery in the brain. </p>
<p>Based on this information, experts know that Fetterman suffered <a href="https://doi.org/10.1161/STR.0000000000000211">an ischemic stroke</a> caused by a blockage of blood flow and oxygen to a certain part of the brain. Ischemic stroke accounts for <a href="https://doi.org/10.1161/CIR.0000000000001052">roughly 85% of the 800,000 new cases of stroke</a> occurring each year in the United States. The remainder are <a href="https://www.stroke.org/en/about-stroke/types-of-stroke/hemorrhagic-strokes-bleeds">hemorrhagic strokes</a> caused by bleeding in or around the brain.</p>
<p>Ischemic stroke often results in a collage of symptoms including facial droop, speech changes and limb weakness, numbness or lack of coordination on one side of the body. These symptoms help bystanders recognize the signs of stroke. When treating ischemic stroke, we in the stroke community use the motto, “Time Is Brain,” because the sooner we can restore <a href="https://doi.org/10.1001/jama.2019.8286">blood flow to the brain</a> after a stroke begins <a href="https://doi.org/10.1161/01.STR.0000196957.55928.ab">the better chance the patient has</a> of making a good recovery. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/uz_DGdiHT5w?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Strokes can occur in people of all ages, and it’s important to recognize the warning signs.</span></figcaption>
</figure>
<p>Fetterman has said publicly that his stroke occurred due to an abnormal rhythm of the heart called <a href="https://www.cdc.gov/heartdisease/atrial_fibrillation.htm">atrial fibrillation</a>. This is a common cause of ischemic stroke, which happens when blood clots form in the heart and travel – or embolize – to the brain. This is the origin of the term “thromboembolism,” which basically means blood clot traveling from one location to another. In the case of atrial fibrillation causing stroke, it refers to a blood clot traveling through arteries from the heart into the brain. </p>
<p>Fortunately, these <a href="https://doi.org/10.1161/STR.0000000000000375">types of stroke are highly preventable</a> simply by taking a daily anticoagulant to prevent the clots from forming. Atrial fibrillation may cause symptoms of fast heart beat or shortness of breath. But often, it is silent, coming and going in short episodes. This makes it more challenging to diagnose and treat. Current guidelines recommend starting an anticoagulant for stroke prevention in high-risk patients with atrial fibrillation.</p>
<h2>Why can stroke lead to auditory processing issues?</h2>
<p>Just like any organ or tissue in the body, normal function in the brain depends on steady blood flow and oxygen. Interruptions in this blood flow – as is the case in ischemic stroke – can lead to permanent injury called <a href="https://www.ahajournals.org/doi/10.1161/STR.0b013e318296aeca?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed">infarction</a>. The location and extent of infarction after a stroke determine what deficits a patient suffer. </p>
<p>In the case of an auditory processing issue, the injury occurs in a part of the brain called the temporal lobe affecting the connection between areas where auditory and language processing occur. In other words, a stroke can disrupt how we hear and process words.</p>
<p>Recovery from stroke depends on a number of variables, including a patient’s age and other medical problems, but largely on the extent of the injury and where it occurs in the brain. </p>
<h2>How do auditory processing issues relate to cognition?</h2>
<p>Auditory processing disorders fall under a larger family of stroke deficits termed aphasia, which have to do with one’s ability to produce or comprehend various forms of language. Aphasia is often categorized as expressive, related to difficulty producing language, or receptive, meaning a difficulty understanding language. </p>
<p>The types of things that aphasia can affect include word finding, grammar, naming, reading and writing. Patients with aphasia can also struggle with <a href="https://www.aphasia.com/aphasia-resource-library/symptoms/paraphasia/#">paraphasic errors</a> – in other words, saying an incorrect word that sounds like the intended word they are trying to say. </p>
<p>Fetterman identified this specific challenge during his NBC News interview, pointing to the example of his saying “emphetic” in place of the word “empathetic.” These issues often get worse during high-pressure situations like debates. What’s unique in Fetterman’s situation is that reading words seems to be easier than hearing them, hence the use of closed captioning during his NBC News interview and his debate. </p>
<p>Aphasia is a common symptom of stroke but can also occur in <a href="https://theconversation.com/what-is-aphasia-an-expert-explains-the-condition-forcing-bruce-willis-to-retire-from-acting-180385">other neurological conditions</a> including various types of dementia.</p>
<p>Most importantly, aphasias and auditory processing disorders <a href="https://www.statnews.com/2022/10/26/for-experts-on-stroke-fetterman-oz-debate-is-a-teachable-moment/">do not necessarily imply other cognitive impairments</a>. In other words, they typically do not alter one’s intelligence, behaviors or executive abilities – neurological functions that are orchestrated by the frontal lobes of the brain. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/sX9LGnbZp1A?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Quick response times are critical in the moments before and after a stroke.</span></figcaption>
</figure>
<h2>What is the typical path of recovery following stroke?</h2>
<p>Fetterman now joins the ranks of more than <a href="https://doi.org/10.1161/str.0000000000000388">7 million Americans and many more around the world</a> who have suffered a stroke, a significant portion of whom remain disabled as a result. Yet, advances in life saving treatments – like the ones Fetterman received – provide hope for stroke patients who were once destined for permanent disability to now walk out of the hospital and return to independent, high-functioning lives. </p>
<p>Typically, recovery from stroke <a href="https://doi.org//10.1161/STR.0000000000000098">occurs along a continuum</a>, from the early hospitalization to a prolonged period of rehabilitation over weeks to months. Depending on the severity of the stroke and resulting deficits, this may require a period of time in an inpatient rehabilitation facility and possibly working with physical, occupational and speech therapists in an outpatient setting. In either case, stroke rehabilitation and recovery is a team sport, requiring collaboration from a multi-disciplinary group of providers along with the support of patient caregivers. </p>
<p>In the field of stroke recovery, patients gain the most ground in the first few months following a stroke event. However, recovery experts know that patients can continue to see gradual improvements well into the first year and beyond. </p>
<p>One thing that’s certain is that stroke survivors like Fetterman are a testament to the advances in clinical research and practice that paved the way for the life-saving treatments like the ones he received. And there’s nothing debatable about that.</p><img src="https://counter.theconversation.com/content/192482/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrew M. Southerland, MD, MSc receives funding from the NIH/NINDS, American Heart Association/American Stroke Association, Abbvie, Inc, and Diffusion Pharmaceuticals, Inc. He is affiliated with the American Academy of Neurology's BrainPAC Executive Committee. </span></em></p>Auditory processing disorders and aphasia can make spoken speech difficult to produce and understand. But these challenges alone do not imply cognitive impairments.Andrew M. Southerland, Professor of Neurology and Public Health Sciences, University of VirginiaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1737692021-12-23T10:42:51Z2021-12-23T10:42:51ZHoliday heart syndrome: binge drinking can cause heart problems<figure><img src="https://images.theconversation.com/files/438845/original/file-20211222-25-1il1tz9.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C6623%2C4412&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/drunk-woman-festive-cap-holding-champagne-1019001784">nelen/Shutterstock</a></span></figcaption></figure><p>Many people enjoy a tipple over the festive season, but overdoing it could cause “holiday heart syndrome”, a condition where the heart beats abnormally – known as atrial fibrillation or AF. This is often experienced as a fluttering in the chest. If it continues for a while and is left untreated, it could lead to a heart attack. </p>
<p>The term holiday heart syndrome was <a href="https://www.sciencedirect.com/science/article/abs/pii/000287037890296X?via%3Dihub">first coined in 1978</a> and is mainly used by doctors in the US. Outside the US, it goes by the slightly less snappy name: <a href="https://www.sciencedirect.com/science/article/pii/S0735109716364695">alcohol-induced atrial arrhythmia</a>.</p>
<p>Scientists can’t be sure how common the condition is, mainly because many people who experience an abnormal heartbeat after drinking alcohol may not seek medical attention. However, a <a href="https://pubmed.ncbi.nlm.nih.gov/3593617/">Finnish study</a>, published in 1987, reported that 5%-10% of new cases of AF were caused by excess alcohol consumption. </p>
<p>AF is rare in people under 30, and isolated episodes of <a href="https://pubmed.ncbi.nlm.nih.gov/29912584/">it in the young</a> are often attributed to endurance exercise, recreational drug use and obesity. However, the most common cause is binge drinking. </p>
<p>The <a href="https://pubmed.ncbi.nlm.nih.gov/16157768/">Copenhagen City Heart Study</a> identified over 1,000 cases of AF among 16,500 men and women. Heavy alcohol use was responsible for 5% of AF cases in men. And the risk of developing AF was found to be 1.5 times higher in binge drinkers compared with those who drank moderate amounts of alcohol or no alcohol at all.</p>
<figure class="align-center ">
<img alt="Three guys drinking shots." src="https://images.theconversation.com/files/438875/original/file-20211222-17-oyybm0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/438875/original/file-20211222-17-oyybm0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/438875/original/file-20211222-17-oyybm0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/438875/original/file-20211222-17-oyybm0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/438875/original/file-20211222-17-oyybm0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/438875/original/file-20211222-17-oyybm0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/438875/original/file-20211222-17-oyybm0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The risk of AF is 1.5 times higher in binge drinkers.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/group-male-friends-drinking-shots-bar-1317105800">Monkey Business Images/Shutterstock</a></span>
</figcaption>
</figure>
<p>Why drinking alcohol <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3998158/">is related to</a> the development of arrhythmia is unclear. There may be a direct toxic effect of alcohol on the cells of the heart muscle or indirect toxic effects from breakdown products (metabolites) either on the heart itself or other organs, such as the endocrine adrenal glands, which are located on the top of each kidney. </p>
<p>Several mechanisms might explain it. First, alcohol interferes with the <a href="https://pubmed.ncbi.nlm.nih.gov/8677879/">nerve conduction in the heart</a>, altering the rate of nerve signal transmission across the heart muscle. Second, alcohol can increase the <a href="https://pubmed.ncbi.nlm.nih.gov/6149396/">release of adrenaline</a> from either the adrenal glands or the heart tissue, which can change the heartbeat leading to arrhythmia. Third, <a href="http://emedicine.medscape.com/article/155050-overview">fatty acids</a> in the blood increase following alcohol consumption and are thought to be associated with the development of AF. Lastly, the <a href="https://pubmed.ncbi.nlm.nih.gov/9141609/">alcohol metabolite acetaldehyde</a> can increase the rate of <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/arrhythmogenesis">abnormal muscle contraction</a>).</p>
<h2>Unanswered questions</h2>
<p>Although scientists have established that excessive alcohol consumption is bad for the heart, some questions remain unanswered. First, we don’t know if the rate of holiday heart syndrome is different in long-term drinkers compared with non-drinkers. Chronic alcohol use is associated with a particular heart problem known as <a href="https://www.nhs.uk/conditions/cardiomyopathy/">alcoholic cardiomyopathy</a>. This is where the heart walls become stretched, thickened or stiff, changing the heart’s ability to pump enough blood around the body. There could be an added risk of holiday heart syndrome if daily alcohol users binge drink. </p>
<p>Second, there is a lack of information on other cardiac risk factors (comorbidities) and their influence on the risk of developing holiday heart syndrome. Genetic factors, type of alcoholic drink (amount of alcohol per unit), speed of consumption and if consumption takes place during fasting or after a meal may all influence the development of AF and holiday heart syndrome. There is, however, one saving grace, in that quitting alcohol reverses the AF-causing effects, and in those with no underlying heart conditions, it seems to have no long-term damaging effect.</p>
<p>A great deal has been investigated relating to alcohol and its effect on the heart, however, much of the published research has focused on moderate intake of alcohol and its ability to protect the heart. Since holiday heart syndrome was first coined over 40 years ago, the public and doctors must be both aware of the toxic effects of alcohol on the heart, especially in those who do not show signs of classical heart diseases.</p>
<p>While the season upon us is to enjoy goodwill and be merry, maybe we should think twice this holiday period before we reach for yet another glass of mulled wine or eggnog.</p><img src="https://counter.theconversation.com/content/173769/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>David C. Gaze does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A bit of alcohol may protect your heart, but binge drinking could send it into a dangerous flutter.David C. Gaze, Senior Lecturer in Chemical Pathology, University of WestminsterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1582292021-04-05T20:06:53Z2021-04-05T20:06:53ZThe media is overhyping early detection tests, and this may be harming the healthy<figure><img src="https://images.theconversation.com/files/393010/original/file-20210401-21-1hyhk22.jpg?ixlib=rb-1.1.0&rect=0%2C17%2C5991%2C3350&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Do you remember hearing about the simple <a href="https://www.irishtimes.com/news/health/new-blood-test-potentially-holy-grail-of-cancer-research-1.3516118">blood test</a> that could tell if you had any of several different cancers? What about the <a href="https://www.thesun.ie/tech/3918297/apple-watch-ecg-feature-that-spots-deadly-heart-condition-arrives-in-uk-and-doctors-say-it-could-save-your-life/">Apple Watch</a> that promised to catch your hidden heart problems before it was too late? Or the <a href="https://www.dailymail.co.uk/health/article-6359979/AI-detects-Alzheimers-disease-SIX-years-early-100-accuracy-small-study.html?ito=amp_whatsapp_share-top">artificial intelligence test</a> to diagnose your dementia years before symptoms appear?</p>
<p>These are not tests for sick people. But the trouble is, testing the healthy can too often wrongly classify them as sick.</p>
<p>Today, in the journal <a href="https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2778372">JAMA Internal Medicine</a>, we’ve published the results of a large global study looking at media coverage of these tests. </p>
<p>We found a disturbing pattern of stories hyping benefits, failing to mention potential harms, and ignoring the conflicts of interest of those promoting the new technologies.</p>
<h2>Turning people into patients</h2>
<p>The idea of catching something early makes a lot of sense, and in some cases can prevent great suffering and extend lives. But the ever earlier detection of disease is causing too much unnecessary diagnosis of many healthy people.</p>
<p>The problem is called <a href="https://theconversation.com/preventing-over-diagnosis-how-to-stop-harming-the-healthy-8569">overdiagnosis</a>, and it’s increasingly recognised as a threat to both human health and health system sustainability.</p>
<p>Overdiagnosis means making people into patients unnecessarily, by identifying and treating problems that were never destined to cause them harm. It causes anxiety, brings side-effects of unnecessary treatments, and wastes resources that could be better spent on genuine need. </p>
<p>Overdiagnosis is driven by <a href="https://www.bmj.com/content/358/bmj.j3879">many factors</a> — cultural and commercial — but also by the increasing availability of sensitive new tests that can detect minor “abnormalities” of sometimes uncertain importance. </p>
<p>Often these tests are aggressively promoted before there’s strong evidence of their benefits, sometimes by companies with obvious interests in maximising markets for their products.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/five-warning-signs-of-overdiagnosis-110895">Five warning signs of overdiagnosis</a>
</strong>
</em>
</p>
<hr>
<p>Cancer is an important example of overdiagnosis. Recent <a href="https://theconversation.com/29-000-cancers-overdiagnosed-in-australia-in-a-single-year-127791">estimates</a> suggest around 29,000 cancers may be overdiagnosed in Australia in a single year. These are cancers that either never grow or grow very slowly, and wouldn’t have spread or caused any problems if left untreated.</p>
<p>Perhaps the most powerful example is the popular PSA (prostate-specific antigen) test used to screen healthy men for prostate cancer, with <a href="https://bmjopen.bmj.com/content/9/3/e022457.long">evidence</a> suggesting 40% of prostate cancer may be overdiagnosed.</p>
<figure class="align-center ">
<img alt="A man consults with a doctor in a bright office." src="https://images.theconversation.com/files/393044/original/file-20210401-19-7gj6m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/393044/original/file-20210401-19-7gj6m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/393044/original/file-20210401-19-7gj6m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/393044/original/file-20210401-19-7gj6m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/393044/original/file-20210401-19-7gj6m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/393044/original/file-20210401-19-7gj6m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/393044/original/file-20210401-19-7gj6m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Early detection tests can be beneficial — but there are also risks that can lead to overdiagnosis.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>Putting the media to the test</h2>
<p>We’ve known for some time that media stories tend to <a href="https://www.nejm.org/doi/full/10.1056/NEJM200006013422206">overhype the benefits</a> of medical treatments. But until our study today, there was no published, peer-reviewed data about how the media globally is covering early detection tests for healthy people.</p>
<p>Our team of researchers from Bond University and the University of Sydney searched three years’ worth of global English language news media coverage, including print, broadcast, and online. We focused on five early detection tests for healthy people:</p>
<ol>
<li><p>liquid biopsy blood tests for multiple cancers</p></li>
<li><p>Apple Watch for atrial fibrillation (abnormal heart rhythm)</p></li>
<li><p>3D mammography for breast cancer </p></li>
<li><p>blood tests for dementia </p></li>
<li><p>artificial intelligence for dementia.</p></li>
</ol>
<p>In particular, we wanted to know whether stories reported on the potential benefits of these tests, such as saving lives, and whether there were any mentions of potential harms, such as overdiagnosis. </p>
<p>We also wanted to know whether these stories featured the views of commentators with financial ties to companies that might benefit from widespread use of the test, and if so, how often the media stories disclosed these conflicts of interest.</p>
<p>We established conflicts of interests using resources including the <a href="https://openpaymentsdata.cms.gov/">Open Payments</a> database in the United States, <a href="https://www.disclosureaustralia.com.au/search/">DisclosureAustralia</a>, and <a href="https://search.disclosureuk.org.uk/">Disclosure UK</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/your-apple-watch-can-now-record-your-ecg-but-what-does-that-mean-and-can-you-trust-it-103430">Your Apple Watch can now record your ECG – but what does that mean and can you trust it?</a>
</strong>
</em>
</p>
<hr>
<h2>Unhealthy reporting</h2>
<p>In total we analysed more than 1,100 news stories, most published in the US, Australia, and the United Kingdom. <a href="https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2778372">We found</a> 97% of all stories reported on benefits, while only 37% reported any harms, and 27% downplayed harms, for example by describing them as negligible.</p>
<p>In other words, while almost all covered benefits, almost two-thirds of stories failed to make any mention of potential harms, and stories that did mention harms tended to downplay them. Further, only one in 20 stories mentioned overdiagnosis. </p>
<figure class="align-center ">
<img alt="A woman controls her Apple watch." src="https://images.theconversation.com/files/393041/original/file-20210401-19-1agq29n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/393041/original/file-20210401-19-1agq29n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/393041/original/file-20210401-19-1agq29n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/393041/original/file-20210401-19-1agq29n.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/393041/original/file-20210401-19-1agq29n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/393041/original/file-20210401-19-1agq29n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/393041/original/file-20210401-19-1agq29n.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The Apple watch can take an electrocardiogram (ECG) to detect atrial fibrillation.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>Hyped headlines raised hopes, with no hint of possible harms. The <a href="https://www.cnbc.com/2018/03/05/alzheimers-blood-test-detects-disease-decades-before-symptoms.html">dementia blood test</a> was described as detecting disease “decades before symptoms”, and the <a href="https://www.thesun.ie/tech/3918297/apple-watch-ecg-feature-that-spots-deadly-heart-condition-arrives-in-uk-and-doctors-say-it-could-save-your-life/">Apple Watch</a> “could save your life”. </p>
<p>We also found more than half (55%) of all stories included the views of commentators with important financial conflicts of interest, but these conflicts were only disclosed in 12% of stories. </p>
<p>The most striking example concerns the Apple Watch. Some 19 of the 22 authors of the <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa1901183">trial</a> examining the watch’s ability to detect atrial fibrillation reported grants or personal fees from Apple. While Apple’s funding of the study was mentioned in 30% of the 273 stories we examined on the Apple Watch, no stories mentioned the conflicts of interest of the individual researchers. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/for-routine-breast-screening-you-may-not-need-a-3d-mammogram-122126">For routine breast screening, you may not need a 3D mammogram</a>
</strong>
</em>
</p>
<hr>
<h2>So what can we do?</h2>
<p>Clearly, there are many great reporters, and much good-quality coverage, often produced under difficult circumstances. But our findings of misleading media promotion of early detection testing — overstating benefits, downplaying harms, and failing to disclose financial interests — risks harming the healthy through causing more overdiagnosis and unnecessary treatment. </p>
<p>We urgently need strategies to improve reporting on early detection tests that target healthy people. Last year we conducted interviews with 22 Australian journalists, including members of the team of health editors at The Conversation, finding an enthusiasm for enhanced training opportunities.</p>
<p>This year, with colleagues from the National Health and Medical Research Council-funded <a href="https://www.wiserhealthcare.org.au/">Wiser Healthcare</a> research collaboration, we’re planning to pilot a suite of interventions including training and tipsheets, which we hope might improve coverage and better inform the public. But perhaps we shouldn’t overstate the potential benefits of our plans.</p><img src="https://counter.theconversation.com/content/158229/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mary O'Keeffe has received research funding from The European Commission. </span></em></p><p class="fine-print"><em><span>Ray Moynihan receives funding from the Australian National Health and Medical Research Council. </span></em></p>In our new study, we’ve found the majority of news stories are failing to cover potential downsides of early detection tests. This could be perpetuating the problem of overdiagnosis.Mary O'Keeffe, Postdoctoral Research Fellow, University of SydneyRay Moynihan, Assistant Professor, Bond UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1463072020-09-26T02:26:43Z2020-09-26T02:26:43ZBody fat deep below the surface is a toxic risk, especially for your heart<figure><img src="https://images.theconversation.com/files/359741/original/file-20200924-18-1gkwwsb.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5760%2C3837&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Amid the COVID-19 pandemic, it’s easy to forget one of the largest health challenges we face remains the global obesity epidemic. <a href="https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight">World Health Organisation data</a> shows obesity has nearly tripled in less than 50 years, with about <a href="https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight">40% of adults worldwide</a> now overweight or obese. High body fat increases the risk of chronic diseases, including heart problems, diabetes and cancer.</p>
<p>However, it’s not simply the total amount of body fat that can increase the risk of disease. The type and location of fat is also important. We’ve known for some time that subcutaneous fat — the fat just below the skin — <a href="https://www.sciencedirect.com/science/article/pii/S0171933513000459">increases inflammation</a> in the body. But in recent years, researchers have realised an even more serious risk is the unseen deep body fat that accumulates around vital organs.</p>
<h2>Fat around organs can be ‘toxic’</h2>
<p>Fat is not all bad — in fact, some fat does a lot of good. It helps protect vulnerable organs and tissues, and provides a convenient energy supply. If you’re out in the cold, it’s essential fuel for body warming through shivering.</p>
<p>But excess fat can increase blood pressure and potentially lead to complications such as heart disease and stroke. Many clinicians use <a href="https://theconversation.com/body-mass-and-evolution-why-the-body-mass-index-is-a-limited-measure-of-public-health-79671">body mass index (BMI)</a> to measure a healthy weight range. It’s calculated as body weight divided by the square of height, and it factors in a healthy amount of fat.</p>
<p>But BMI can’t provide information about the shape and size of potentially dangerous internal fat deposits, known as “visceral fat”. Over recent years it’s become apparent visceral fat can lead to disease, and good fat can turn into toxic fat when there is too much.</p>
<figure class="align-center ">
<img alt="A person with obesity" src="https://images.theconversation.com/files/359744/original/file-20200924-16-1a1snd6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/359744/original/file-20200924-16-1a1snd6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/359744/original/file-20200924-16-1a1snd6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/359744/original/file-20200924-16-1a1snd6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/359744/original/file-20200924-16-1a1snd6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/359744/original/file-20200924-16-1a1snd6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/359744/original/file-20200924-16-1a1snd6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">It’s well-known high amounts of body fat can lead to further health problems. But lesser-known is that deep fat wrapped around organs can release damaging molecules.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>Various organs seem to accumulate visceral fat. This can be a problem because it can create and release damaging molecules and hormones into the blood. These are transported in the bloodstream, potentially causing health complications in distant parts of the body.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/obesity-has-become-the-new-normal-but-its-still-a-health-risk-118829">Obesity has become the new normal but it's still a health risk</a>
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<p>For example, toxic fat can release proteins that blunt the body’s sensitivity to insulin. Blood glucose levels then rise, potentially <a href="https://www.diabetes.co.uk/body/visceral-fat.html">causing diabetes in the long term</a>. Visceral fat can also stimulate uncontrolled cell growth and replication, <a href="https://www.cancer.gov/about-cancer/causes-prevention/risk/obesity/obesity-fact-sheet">potentially triggering some forms of cancer</a>. A fatty liver is associated with metabolic diseases, and excess kidney fat interferes with the body’s fluid balance.</p>
<h2>The heart is especially vulnerable</h2>
<p>Visceral fat can also directly affect the organ around which it’s wrapped. Our <a href="https://www.onlinejacc.org/content/76/10/1197?download=true">new research</a>, published in September in the Journal of the American College of Cardiology, found visceral fat around the heart produces biochemical molecules that can make the heart beat erratically. These molecules potentially cause a serious heart condition called <a href="https://www.heartfoundation.org.au/conditions/atrial-fibrillation">atrial fibrillation</a>, by disrupting the heart’s electrical activity.</p>
<p>Atrial fibrillation is one of the most common types of heart rhythm disturbance, and <a href="https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehaa612/5899003">one in three people</a> over 55 will develop the condition. It occurs when the regular signal to drive each heartbeat originating in the top portion of the heart, the atria, is disrupted. It can cause an irregular and chaotic heartbeat, disrupting the heart’s coordinated pumping action. This can mean not enough fresh blood is circulated to allow regular daily activity.</p>
<p>For some people, living with episodes of atrial fibrillation is a daily challenge – coping with bouts of dizziness, the distressing awareness of a “racing heart”, and chest palpitations. Other people may be unaware they have the condition and the first sign could be tragic, such as a stroke due to a blood clot travelling to the brain. This can lead to <a href="https://www.heartfoundation.org.au/conditions/heart-failure">heart failure</a>.</p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/UQd3VA5HgfA?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">An advertisement from the Western Australian health department warning viewers about toxic fat. Only in recent years have researchers discovered the dangers of hidden fat around organs.</span></figcaption>
</figure>
<p>We worked with clinical cardiologists at the Royal Melbourne Hospital and found fat around the heart secretes molecules which change how nearby cells “talk” to each other, slowing cell-to-cell communication. Because the transfer of electrical signals in the heart muscle are delayed, the heartbeat is potentially destabilised.</p>
<p>Although a high BMI increases the risk of atrial fibrillation, it’s the fat burden on the heart, and not BMI itself, that’s most important in electrical and structural disruption. </p>
<p>This suggests toxic substances released from the surrounding fat can directly harm the nearby organ, without travelling via the blood.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/evidence-obesity-is-a-risk-factor-for-serious-illness-with-coronavirus-is-mounting-even-if-youre-young-137081">Evidence obesity is a risk factor for serious illness with coronavirus is mounting – even if you're young</a>
</strong>
</em>
</p>
<hr>
<p>For heart patients, these findings mean the surgical removal of cardiac fat could be an effective treatment to consider. Also, it potentially paves the way for the future development of drugs that can suppress the release of damaging molecules from hidden fat.</p>
<p>Nevertheless, these findings underscore the danger of an “obese heart”, particularly amid the COVID-19 pandemic. Research is emerging that obesity is a major risk factor for <a href="https://www.cdc.gov/obesity/data/obesity-and-covid-19.html">serious complications while infected with the virus</a>, and the fat load on the heart may be implicated.</p><img src="https://counter.theconversation.com/content/146307/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lea M D Delbridge receives funding from the National Health and Medical Research Council of Australia. </span></em></p><p class="fine-print"><em><span>James Bell receives funding from National Health and Medical Research Council. </span></em></p>Our new research shows deep body fat wrapped around the heart can release dangerous molecules, potentially leading to atrial fibrillation.Lea M D Delbridge, Professor of Physiology, The University of MelbourneJames Bell, Lecturer In Human Physiology, Physiology Anatomy & Microbiology, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1034302018-09-19T20:13:56Z2018-09-19T20:13:56ZYour Apple Watch can now record your ECG – but what does that mean and can you trust it?<figure><img src="https://images.theconversation.com/files/237025/original/file-20180919-158222-s8owz9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Apple's smart watch can now read your heart current.</span> <span class="attribution"><span class="source">from shutterstock.com</span></span></figcaption></figure><p>Apple’s new, fourth-generation watch has an <a href="https://www.apple.com/uk/newsroom/2018/09/redesigned-apple-watch-series-4-revolutionizes-communication-fitness-and-health/">electrical heart rate sensor</a>. This can record your electrocardiogram or ECG, which Apple says:</p>
<blockquote>
<p>… can classify if the heart is beating in a normal pattern or whether there are signs of atrial fibrillation (AFib), a heart condition that could lead to major health complications.</p>
</blockquote>
<p>So, what actually is an ECG and can you really rely on a watch to read it?</p>
<h2>How does the heart beat?</h2>
<p>As a quick summary, your heart is divided into four chambers. The two top chambers (called atria) receive blood and push it towards the two bottom chambers (ventricles), which pump blood out to the body (left side) and the lungs (right side).</p>
<p>At the top of the right atrium is a little collection of cells called the sinoatrial node, or SA node. These generate an electrical signal which travels toward the middle of the heart (atrioventricular node). Finally, this electrical impulse spreads into the ventricles, which makes them squeeze blood for what we feel as a heartbeat or pulse. A <a href="https://theconversation.com/what-should-my-heart-rate-be-and-what-affects-it-98945">normal heart rate</a> can vary significantly between different people.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-should-my-heart-rate-be-and-what-affects-it-98945">What should my heart rate be and what affects it?</a>
</strong>
</em>
</p>
<hr>
<p>So, these small electrical currents help co-ordinate each beat. In the early 1900s, Willem Einthoven developed a machine to be able to record these signals (for which he was awarded the Nobel Prize) – a device that developed into the modern-day ECG machine. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/237020/original/file-20180919-158237-17p8ni1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/237020/original/file-20180919-158237-17p8ni1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/237020/original/file-20180919-158237-17p8ni1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=601&fit=crop&dpr=1 600w, https://images.theconversation.com/files/237020/original/file-20180919-158237-17p8ni1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=601&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/237020/original/file-20180919-158237-17p8ni1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=601&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/237020/original/file-20180919-158237-17p8ni1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=755&fit=crop&dpr=1 754w, https://images.theconversation.com/files/237020/original/file-20180919-158237-17p8ni1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=755&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/237020/original/file-20180919-158237-17p8ni1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=755&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Your heart is made up of four chambers.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>An ECG involves having small stickers applied to your chest, shoulders and ankles, which can then read the electricity coming from your heart. You don’t feel anything when it is taken and it takes only a few seconds to make a recording. It can be done at your local GP clinic or in hospital.</p>
<h2>How does an ECG work?</h2>
<p>With every beat, there is a characteristic appearance of each signal on the ECG, with separate “waves” that correspond to electrical activity from different parts of the heart.</p>
<p>The P wave (before the spike) represents the atria squeezing blood down towards the ventricles. The QRS looks like a spike and represents the two ventricles squeezing blood to the body and lungs. And the T wave at the end reflects the recovery of the ventricles as they relax to receive blood again.</p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/237024/original/file-20180919-158240-ijzvu6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/237024/original/file-20180919-158240-ijzvu6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/237024/original/file-20180919-158240-ijzvu6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=661&fit=crop&dpr=1 600w, https://images.theconversation.com/files/237024/original/file-20180919-158240-ijzvu6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=661&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/237024/original/file-20180919-158240-ijzvu6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=661&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/237024/original/file-20180919-158240-ijzvu6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=830&fit=crop&dpr=1 754w, https://images.theconversation.com/files/237024/original/file-20180919-158240-ijzvu6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=830&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/237024/original/file-20180919-158240-ijzvu6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=830&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Each beat is represented by a separate wave or spike on the ECG.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>By analysing various segments, the person reading the ECG can understand about problems, signalled by an abnormal-looking ECG, in the heart. The ECG can usually detect severe or urgent heart attacks, which cause elevation of the segment between the QRS and T waves. Smaller heart attacks sometime show signs, but not always. </p>
<p>The ECG is good for detecting arrhythmias, which are abnormal rhythms. The most common arrhythmia is atrial fibrillation (AF) – this is where the top chambers (the atria) don’t squeeze properly. As a result blood can stagnate and form a clot, which can then go to the brain and cause a stroke. </p>
<p>You can see atrial fibrillation on an ECG when no P wave is visible. Instead there are often small irregular blips indicating that the atrium is beating in a weak and disorganised way. An ECG can also pick up other arrhythmias, though it is most useful if the person is in the abnormal rhythm at the time the ECG is done.</p>
<p>The ECG can also pick up abnormal heart structures. Sometimes it can show signs of the heart being weak (heart failure) or if the muscle is unusually thick, such as when people have high blood pressure for a long time. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/tom-petty-died-from-a-cardiac-arrest-what-makes-this-different-to-a-heart-attack-and-heart-failure-85245">Tom Petty died from a cardiac arrest – what makes this different to a heart attack and heart failure?</a>
</strong>
</em>
</p>
<hr>
<h2>So, can the Apple Watch actually read your heart?</h2>
<p>The ECG at your local doctor is called a 12-lead ECG. Only ten leads are physically attached to you, but the machine derives 12 based on the direction of electrical flow. Each of these leads provide a different view of the heart. </p>
<p>Imagine you are peering into a room through several windows. Each window would give you a different perspective, and putting these together can give you an overall impression of the room.</p>
<p>Wearable ECGs, like that with the Apple Watch, can pick up only one lead (for your further reading, it’s lead I). This can tell if your heart is irregular and sometimes if there is no P wave (so it could potentially detect atrial fibrillation). </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/237018/original/file-20180919-143281-1fed0br.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/237018/original/file-20180919-143281-1fed0br.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/237018/original/file-20180919-143281-1fed0br.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/237018/original/file-20180919-143281-1fed0br.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/237018/original/file-20180919-143281-1fed0br.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/237018/original/file-20180919-143281-1fed0br.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/237018/original/file-20180919-143281-1fed0br.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/237018/original/file-20180919-143281-1fed0br.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">An ECG involves several stickers placed on your chest.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>A key advantage of having the Apple Watch is the ability to take a 30-second ECG (this requires you to put your right hand on the watch to form a circuit so the electrical signals can be read from both arms through your heart) at the time you feel symptoms. It can understand the context as well (for example, your activity level at the time). </p>
<p>There are drawbacks, though. The watch can only give a single-window view of what’s happening in the heart, and won’t be able to detect heart attacks or abnormal heart structure accurately. Wearable devices are also more prone to interference with the signal as they rely on just one lead, whereas a 12-lead ECG remains the gold standard.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/new-apple-watch-adds-heart-tracking-heres-why-we-should-welcome-ecg-for-everyone-103375">New Apple Watch adds heart tracking: here's why we should welcome ECG for everyone</a>
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<p>And, of course, the actual ECG must be read by a professional. Apple gives you the option to download your reading as a PDF. </p>
<p>Ultimately, if you have concerns about your heart, an ECG is a simple, non-invasive, cheap test, which your local doctor can interpret. It should always be accompanied by a detailed history of your symptoms and a physical examination.</p><img src="https://counter.theconversation.com/content/103430/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Shane Nanayakkara receives funding from the Heart Foundation and the Baker Heart and Diabetes Institute. </span></em></p><p class="fine-print"><em><span>Anna Beale does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The new Apple Watch is making waves for being able to record an electrocardiogram (ECG) and share it. An ECG can tell you what’s going on with your heart.Shane Nanayakkara, Cardiologist, Baker Heart and Diabetes InstituteAnna Beale, Medical doctor, PhD candidate in cardiology, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/996432018-07-11T08:40:29Z2018-07-11T08:40:29ZHow GPs are preventing thousands of strokes in the UK<figure><img src="https://images.theconversation.com/files/226946/original/file-20180710-70048-xt62of.jpg?ixlib=rb-1.1.0&rect=0%2C46%2C1000%2C585&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/97918313?src=J3Gwbs3m6FCqidap2wreEg-1-11&size=medium_jpg">sfam_photo/Shutterstock.com</a></span></figcaption></figure><p>On its 70th anniversary, there is good news from the NHS. About 7,000 strokes have been prevented, per year, thanks to GPs getting better at identifying people with a common form of heart arrhythmia known as atrial fibrillation and thanks to more of these people being prescribed anticoagulant drugs.</p>
<p>Atrial fibrillation is a heart condition where the heart beats irregularly and often very fast. It happens when electrical impulses in the heart fire in a disorganised way, causing the atria (the top chambers of the heart) to flutter.</p>
<p>Although the exact cause of atrial fibrillation is <a href="https://www.nhs.uk/conditions/atrial-fibrillation/causes/">not known</a>, several <a href="http://circres.ahajournals.org/content/114/9/1453.long#T1">risk factors</a> have been identified, including increased age, male sex, high blood pressure, heart valve disease, diabetes and thyroid disease. </p>
<p>There are about <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/644869/atrial_fibrillation_AF_briefing.pdf">1.7m people</a> in the UK with atrial fibrillation, according to Public Health England. </p>
<p>People with the condition are <a href="https://www.ncbi.nlm.nih.gov/pubmed/1866765">four times more likely</a> to suffer from a stroke, and the strokes they suffer are more likely to leave them disabled or result in death. </p>
<p>Doctors have known for two decades that two thirds of these strokes could be prevented with anticoagulants – drugs that prevent blood clotting. As a result, anticoagulants are recommended for almost everyone with the condition, apart from a small number who are young and do not have any other risk factors.</p>
<p><a href="https://www.ncbi.nlm.nih.gov/pubmed/28572399">Earlier research</a> from our team identified room for improvement in preventing stroke. We showed that patients with intermittent atrial fibrillation were less likely to be treated, even though they are just as likely to benefit. We also <a href="https://www.bmj.com/content/361/bmj.k1717">showed</a> that one in ten patients have a record showing that their atrial fibrillation has resolved, nevertheless they continue to be at high risk of stroke. Despite this, few people in this group are prescribed anticoagulants. </p>
<p>Once a patient has been labelled by their GP as “AF resolved”, they are no longer on the atrial fibrillation register and so they are no longer followed up by their doctor. But this problem could be resolved with a simple change to the rules for incentive payments, encouraging GPs to keep these patients on the register.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/226947/original/file-20180710-70069-o1mb7m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/226947/original/file-20180710-70069-o1mb7m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=481&fit=crop&dpr=1 600w, https://images.theconversation.com/files/226947/original/file-20180710-70069-o1mb7m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=481&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/226947/original/file-20180710-70069-o1mb7m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=481&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/226947/original/file-20180710-70069-o1mb7m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=605&fit=crop&dpr=1 754w, https://images.theconversation.com/files/226947/original/file-20180710-70069-o1mb7m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=605&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/226947/original/file-20180710-70069-o1mb7m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=605&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/89144557?src=3m-MqVOYty7hFvVPX-xg8g-1-6&size=medium_jpg">Alila Medical Media/Shutterstock.com</a></span>
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<h2>Quiet revolution</h2>
<p>To prevent strokes, two things have to happen: patients with atrial fibrillation need to have their condition diagnosed, and they need to be treated. For our latest study, published in the journal <a href="https://heart.bmj.com/content/heartjnl/early/2018/07/04/heartjnl-2018-312977.full.pdf?ijkey=hKxa8sSDXNzO0yc&keytype=ref">Heart</a>, we wanted to know how good the NHS is at identifying and treating atrial fibrillation. </p>
<p>To answer this, we identified how many patients were diagnosed with atrial fibrillation in each year, from 2000 to 2016, and how many of these known patients were on treatment. </p>
<p>For men and women, in all age groups, the number of people diagnosed with atrial fibrillation increased year on year. In 2000, the number of people diagnosed with atrial fibrillation was about 800,000. By 2016, this figure had increased to 1.2m – a 50% increase. </p>
<p>Detection and diagnosis have clearly improved. But shouldn’t we have identified all of the estimated 1.7m people with atrial fibrillation? It turns out that this estimate is just that – an estimate. The NHS might be close to identifying everybody with the condition. At worst, it has identified three quarters of those with the condition.</p>
<p>What about treatment? Here again, it’s good news. In 2000, only 35% of patients with atrial fibrillation received anticoagulants; by 2016, the figure had more than doubled to 76%. Alongside this, fewer people are being treated unnecessarily. Young people with atrial fibrillation who have no other risk factors don’t need to take the medication. Among this group, one in five were being treated in 2000, but by 2016 that figure had fallen to one in ten. </p>
<p>Over 16 years there has been a quiet revolution in stroke prevention in UK general practice, a revolution that may be preventing 7,000 strokes a year. There is scope for improvement, but in its 70th year, the NHS is in robust health.</p><img src="https://counter.theconversation.com/content/99643/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tom Marshall is funded by the NIHR Collaborations for Leadership in Applied Health Research and Care West Midlands initiative. This paper presents independent research and the views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. </span></em></p>Over the past 16 years, GPs have got much better at diagnosing and treating people with atrial fibrillation. And it’s saving lives.Tom Marshall, Professor of Public Health and Primary Care, University of BirminghamLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/574422016-04-11T14:31:30Z2016-04-11T14:31:30ZYou really can die of a broken heart – here’s the science<figure><img src="https://images.theconversation.com/files/118133/original/image-20160411-21959-ps6nll.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A fatal flaw?</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/cat.mhtml?lang=en&language=en&ref_site=photo&search_source=search_form&version=llv1&anyorall=all&safesearch=1&use_local_boost=1&autocomplete_id=&searchterm=broken%20heart&show_color_wheel=1&orient=&commercial_ok=&media_type=images&search_cat=&searchtermx=&photographer_name=&people_gender=&people_age=&people_ethnicity=&people_number=&color=&page=1&inline=112793704">Shutterstock</a></span></figcaption></figure><p>When you think of a broken heart, you probably picture something out of a romantic movie or a cartoon heart, cracked like a fragile piece of china. Indeed, so-called <a href="http://www.heart.org/HEARTORG/Conditions/More/Cardiomyopathy/Is-Broken-Heart-Syndrome-Real_UCM_448547_Article.jsp">“broken heart syndrome”</a> has a certified place in popular culture, and has been eloquently used in films such as <a href="http://www.imdb.com/title/tt0332280/">The Notebook</a>. But while we certainly feel “heartbreak” during periods of emotional upheaval, can you actually die of a broken heart? </p>
<p>The answer is never going to be simple, so first we should start with a bit of science. In the last two decades, <a href="http://www.nhs.uk/Conditions/atrial-fibrillation/Pages/Introduction.aspx">atrial fibrillation (AF)</a>, a form of irregular heartbeat, has become one of the most important public health problems and a significant cause of increasing healthcare costs in western countries. </p>
<p>Individuals with AF have a five-fold and two-fold increased risk of stroke and death, respectively. It is <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4064952/">estimated</a> that there will be 14-17m AF patients in Europe by 2030; with 120,000–215,000 new cases diagnosed each year. In the United States, AF prevalence is <a href="http://www.ajconline.org/article/S0002-9149(13)01288-5/abstract">projected</a> to increase from 5.2m in 2010 to 12.1m cases in 2030. </p>
<p>The exact cause of AF is still unresolved and is likely to involve multiple components such as genetic and environmental factors. Atrial fibrillation is a progressive condition, whereby the arrhythmia begins in a “sudden onset” form, progressing through “persistent” to so-called “permanent” AF. These steps can take many years to develop, but an essential element in this progression are the so-called “triggers”, which can be anything from illness and fatigue, to alcohol, caffeine and emotional stress.</p>
<h2>Bereavement and ‘broken hearts’</h2>
<p>But what does this have to do with a broken heart? Well, it appears that the two are linked. In a <a href="http://openheart.bmj.com/content/3/1/e000367.abstract">recent article</a> published in the online journal Open Heart, a Danish research team based at Aarhus University reported findings showing that the death of a partner is linked to heightened risk of developing AF for up to a year after the bereavement. </p>
<p>This retrospective study examined hospital records of 88,612 people in Denmark (19.72% of whom had lost a partner) and identified persons that were diagnosed with AF for the first time between 1995 and 2014. For comparison, the team also randomly selected a control group (without AF) of 886,120 people (19.07% of whom had lost a partner) which was matched with the AF group on age and gender. Other factors that were controlled included civil status and education level, and whether the subjects had cardiovascular disease, diabetes or were taking medication for cardiovascular disease.</p>
<p>The study revealed that individuals whose cohabiting partner or spouse had died had an increased risk of getting AF within 30 days of the bereavement – a risk estimated to be 41% higher than average.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/118141/original/image-20160411-21950-1v8t940.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/118141/original/image-20160411-21950-1v8t940.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/118141/original/image-20160411-21950-1v8t940.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/118141/original/image-20160411-21950-1v8t940.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/118141/original/image-20160411-21950-1v8t940.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/118141/original/image-20160411-21950-1v8t940.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/118141/original/image-20160411-21950-1v8t940.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Bereavement: can be bad for your health.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/cat.mhtml?lang=en&language=en&ref_site=photo&search_source=search_form&version=llv1&anyorall=all&safesearch=1&use_local_boost=1&autocomplete_id=&searchterm=bereavement&show_color_wheel=1&orient=&commercial_ok=&media_type=images&search_cat=&searchtermx=&photographer_name=&people_gender=&people_age=&people_ethnicity=&people_number=&color=&page=1&inline=249465919">Shutterstock</a></span>
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<p>The risk was highest 8-14 days after the loss (90% higher than average) and gradually declined to a level close to that of non-bereaved population after one year. This risk was higher among people under the age of 60 and among those whose death was unexpected. Interestingly, where deaths were likely due to ill health, there was no increased risk of AF in the partners after the loss.</p>
<p>The main strengths of this study are the large sample size and the population-based design, but it is an observational study and they can’t prove the cause or the effect. Other contributory factors such as lifestyle or family history of AF could have affected the results, which the authors have acknowledged. </p>
<p>What would have provided more insight to this study is if blood biomarkers (indicating heart damage) or stress hormones (such as adrenaline) were monitored during hospital admission, or whether there were other more serious heart problems, such as heart failure, which would have been detectable with the use of <a href="https://www.heart.org/idc/groups/heart-public/@wcm/@hcm/documents/downloadable/ucm_300438.pdf">echocardiography</a>.</p>
<h2>The origins of a broken heart</h2>
<p>Scientific findings accumulated over the past 25 years seem to support the notion that a real-life broken heart can lead to subsequent heart problems. “Broken heart syndrome”, also known as stress-induced cardiomyopathy or Takotsubo cardiomyopathy, was first described in 1990 in Japan and has recently been globally recognised as a <a href="https://www.bhf.org.uk/heart-health/conditions/cardiomyopathy/takotsubo-cardiomyopathy">real medical condition</a>. </p>
<p>It should be noted here that without echocardiography, blood markers and other evidence, we can’t say for sure whether those in the published Danish cohort had “broken heart syndrome” or not. Nevertheless, roughly in keeping with the condition described in the Danish study, Takotsubo cardiomyopathy starts abruptly and unpredictably (even in healthy individuals). Symptoms include chest pains, often with shortness of breath, and an abnormal electrocardiogram, which resembles a heart attack but is notable for the absence of blocked heart blood vessels. </p>
<p>Indeed, Takotsubo syndrome <a href="http://www.health.harvard.edu/heart-health/takotsubo-cardiomyopathy-broken-heart-syndrome">accounts</a> for about 2-5% of heart attack cases seen by doctors, with a higher predilection for women over 50 years of age (only 10% in men). The significance of Takotsubo cardiomyopathy is reflected to the fact that there is an <a href="http://www.takotsubo-registry.com">international registry for this disorder</a>. </p>
<p>What is interesting is that Takotsubo cardiomyopathy is usually triggered by an emotionally or physically stressful event such as bereavement, major surgery or being involved in a disaster such as an earthquake. The exact mechanisms leading to Takotsubo cardiomyopathy are unknown but some evidence suggests excessive release of stress hormones, such as adrenaline, acts as a trigger during the initial onset which causes the weakening of the heart muscle. </p>
<p>In fact, the strong emotion doesn’t have to be negative – <a href="http://www.ncbi.nlm.nih.gov/pubmed/26935270">“happy heart syndrome”</a> is initiated by happy events, such as the birth of grandchildren or a birthday, and accounts for 1.1% of <a href="http://www.readcube.com/articles/10.1038/nrcardio.2016.41">broken heart syndrome cases</a>.</p>
<p>The long-term affects of Takotsubo cardiomyopathy are unclear, but it does appear to be temporary and reversible. Nevertheless, it is certain that we can have our hearts broken – and that, for some, this can be very dangerous indeed.</p><img src="https://counter.theconversation.com/content/57442/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nelson Chong does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>In fact, even a happy heart can break.Nelson Chong, Senior Lecturer, Department of Life Sciences, University of WestminsterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/572842016-04-07T06:54:37Z2016-04-07T06:54:37ZDeath of a partner can endanger your heart health<figure><img src="https://images.theconversation.com/files/117774/original/image-20160407-13972-19thc75.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">We found those grieving for a lost spouse are at an increased risk of atrial fibrillation.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/ashleyrosex/4577243908/in/photolist-7Ytz9q-nqecf5-6fSWMq-7cUQZM-9Q8baK-8Ydz7H-7yNvq-atMLeP-tEsAP-3UN759-nqegpi-rk2DxK-dCCU93-6ifHvf-its39H-6fNCyF-iyN7iY-djmoj-6zSE6S-4nBGW8-3dkpS-6pypTD-ap6JhZ-4TLkM-pCeAiK-6ZkSPD-cFv3YL-6pCvB7-6fSNKq-3bJA4o-nB5JZn-6fNEBM-dths1d-DMGaWC-2fqC2-4Mg1sk-kiPm9T-dugcss-4Qt7vT-5AJiDA-5LH3Kw-6kGpox-6fSNBA-CyKEvL-fhV7-4VuKNr-5RZ7Rr-4rr4WT-nqerw3-rWbZY">ashley rose,/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>For decades, medicine has recognised the powerful way grief can influence the heart. It’s been called <a href="https://theconversation.com/fact-or-fiction-can-we-die-from-a-broken-heart-46131">Broken Heart syndrome</a> or <a href="http://www.ncbi.nlm.nih.gov/pubmed/24552225">Takotsubo cardiomyopathy</a> and evidence that severely stressful life events <a href="http://archinte.jamanetwork.com/article.aspx?articleid=1832196">increase the risk of acute cardiovascular incidence</a>, like a heart attack, continues to grow.</p>
<p>Meanwhile, anecdotal reports and <a href="http://www.internationaljournalofcardiology.com/article/S0167-5273(13)00658-X/abstract">case studies</a> have long described the relationship between acute stress and the <a href="http://jama.jamanetwork.com/article.aspx?articleid=207958">development of an irregular heartbeat</a>, known as cardiac arrhythmia. </p>
<p>The most common form of cardiac arrhythmia in the western world is atrial fibrillation, where the heart beats improperly (usually more rapidly) and irregularly. But, so far, no large studies had examined the link between stressful life events and atrial fibrillation.</p>
<p>Our study, conducted at Aarhus University and published in the journal <a href="http://openheart.bmj.com/content/3/1/e000367">Open Heart</a> this week, was based on data from nearly one million patients. It has shown a significant link between loss of a partner and development of atrial fibrillation. </p>
<p>We found the risk of developing an irregular heartbeat for the first time was 41% higher among those grieving a partner’s loss compared to those who hadn’t experienced such loss.</p>
<p>We also found the condition could persist for up to a year after the tragic event.</p>
<p>This is concerning as atrial fibrillation is associated with <a href="http://circ.ahajournals.org/content/98/10/946.full">increased risk of death</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed/15879330">stroke</a> and <a href="http://www.ncbi.nlm.nih.gov/pubmed/12771006">heart failure</a>. An irregular heartbeat has also been linked to lower <a href="http://www.ncbi.nlm.nih.gov/pubmed/23265334">quality of life</a>. A person’s estimated lifetime risk of atrial fibrillation is between 22% and 26% and the condition is <a href="http://www.ncbi.nlm.nih.gov/pubmed/24763464">one of the few heart diseases</a> with increasing incidence. </p>
<h2>A closer look at our study</h2>
<p>In our population-based case-control study, we took information about 88,612 patients in Denmark who were newly diagnosed with atrial fibrillation between 1995 and 2014 and compared it with 886,120 healthy people. </p>
<p>Both groups were matched on age and sex. Among those with atrial fibrillation, 17,478 had lost a partner. In the control group, this number was 168,940.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/117777/original/image-20160407-13975-18p7jwq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/117777/original/image-20160407-13975-18p7jwq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/117777/original/image-20160407-13975-18p7jwq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/117777/original/image-20160407-13975-18p7jwq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/117777/original/image-20160407-13975-18p7jwq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/117777/original/image-20160407-13975-18p7jwq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/117777/original/image-20160407-13975-18p7jwq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Death of a partner is considered one of the most stressful life events.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
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<p>We looked at several factors that might influence the risk of atrial fibrillation, including age, sex, patients’ underlying health conditions and the health of their partner a month before the death.</p>
<p>We found the risk of developing atrial fibrillation was highest eight to 14 days after a partner’s loss and remained elevated for a year. The risk was higher in those under 60 years olds and the effect was most dramatic in those who had unexpectedly lost a healthy partner.</p>
<p>The heightened risk was apparent irrespective of gender and other underlying health conditions.</p>
<p>Those with partners who were relatively healthy in the month before death were 57% more likely to develop an irregular heartbeat, but no increased risk was seen among those whose partners were ill and expected to die soon.</p>
<h2>The link between body and mind</h2>
<p>Our study is the first to show that severe stress could play a significant role in the development of atrial fibrillation. </p>
<p>The exact mechanisms linking the mind and heart, however, aren’t certain.</p>
<p>Studies have suggested acute stress may directly disrupt normal heart rhythms and prompt the <a href="http://www.ncbi.nlm.nih.gov/pubmed/0010217662">production of chemicals involved</a> in inflammation, which is a physical response to injury or infection.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/117778/original/image-20160407-13980-o66moi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/117778/original/image-20160407-13980-o66moi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/117778/original/image-20160407-13980-o66moi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=429&fit=crop&dpr=1 600w, https://images.theconversation.com/files/117778/original/image-20160407-13980-o66moi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=429&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/117778/original/image-20160407-13980-o66moi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=429&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/117778/original/image-20160407-13980-o66moi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=539&fit=crop&dpr=1 754w, https://images.theconversation.com/files/117778/original/image-20160407-13980-o66moi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=539&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/117778/original/image-20160407-13980-o66moi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=539&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">The central nervous system modules heart rhythm.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
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<p>Bereavement, such as after the loss of a partner, <a href="http://www.sciencedirect.com/science/article/pii/S0140673607618169">often brings about symptoms of mental illness</a> such as depression, anxiety, guilt, anger and hopelessness. Losing a partner to death <a href="http://www.sciencedirect.com/science/article/pii/0022399967900104">ranks highly</a> on a psychological scale of severely stressful life events. </p>
<p>Such stress could affect basic hormonal processes. The release of adrenalin, for instance, is useful in acute danger – as it increases your heart rate and diverts blood to your muscles so you can run or fight – but it can disrupt heart rhythm if the release is excessive and prolonged.</p>
<p>Acute mental stress may also create imbalance in the central nervous system – the autonomic nervous system – that controls many basic functions. It also <a href="http://www.ncbi.nlm.nih.gov/pubmed/22853984">modulates our heart frequency</a> and the electrical nerve pathways that run through the heart to the muscle, <a href="http://www.ncbi.nlm.nih.gov/pubmed/14522493">facilitating a synchronised contraction</a> of the heart chambers.</p>
<h2>Those grieving need special attention</h2>
<p>Our study indicates that people experiencing severe mental stress from bereavement are a vulnerable group that might need more medical attention. </p>
<p>With a biologically plausible association, early identification of this group is currently a major challenge in the health-care system.</p>
<p>The study’s findings don’t just have significant clinical relevance though. We are currently experiencing substantial levels of stress in modern society. And while stress is a potentially modifiable risk factor, many people develop stress-related illnesses, that are a key driver to growing health-care costs.</p><img src="https://counter.theconversation.com/content/57284/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Simon Graff have recieved funding from The Lundbeck Foundation. </span></em></p>The risk of developing an irregular heartbeat was 41% higher among those who were grieving a partner’s loss than among those who hadn’t experienced such loss. And this could last up to a year.Simon Graff, Research assistant, Institute for Public Health, Aarhus UniversityLicensed as Creative Commons – attribution, no derivatives.