Healthcare

Atrial Fibrillation: Improving care pathways to meet the rising burden across the Asia-Pacific region

September 14, 2022

Asia, Australasia

Atrial Fibrillation: Improving care pathways to meet the rising burden across the Asia-Pacific region

September 14, 2022

Asia, Australasia
Gerard Dunleavy

Manager

Gerard is a Manager with Economist Impact’s Health Policy team. He manages global engagements with international clients in the healthcare sector, from conceptualising to delivering and executing customised research projects. He manages multidisciplinary teams, conducting both quantitative and qualitative analyses, across a broad range of disease areas and health policies.
Prior to joining Economist Impact, Gerard worked in academic settings specialising in evidence-based synthesis and epidemiological studies. He holds a PhD in Public Health and Epidemiology and a Masters degree in Health Education and Promotion, both from Maastricht University.

Atrial fibrillation (AFib) is the most common cardiac arrhythmia (heart rhythm disorder) among adults. The condition can be diagnosed during routine cardiac screening because of new onset symptoms or as an incidental finding in asymptomatic individuals.
 
The prevalence of AFib in the Asia-Pacific region has increased in recent decades and this trend looks set to continue. By 2050, it is estimated that 49 million men and 23 million women in the region will carry a diagnosis of AFib. There are multiple factors contributing to the rising prevalence of AFib in the region, which include: an ageing population; a rise in the incidence of risk factors for AFib, such as obesity, hypertension, metabolic syndrome and diabetes; enhanced detection; and increased survival with chronic diseases, including greater survival among patients with AFib.
 
This report provides a snapshot of the status of and challenges along the care pathway for patients with AFib in five Asia-Pacific countries (Australia, China, India, Japan and South Korea). Despite the differences in diagnostic methods and clinical settings, the countries were chosen to generate a representative sample across parameters such as per capita income, population size, AFib prevalence, and structural features of health systems.
 
Through rigorous desk research and in-depth discussions with relevant clinical and policy stakeholders, as well as patient advocates, Economist Impact identified checkpoints for intervention in the AFib care pathway that could help improve patient outcomes and lower healthcare costs.
 
Key insights from our research include:
  • Stakeholders from the five countries, focused in this report, highlighted a lack of awareness of AFib and its consequences as one of the most significant challenges for the condition. The lack of awareness manifests in different ways and among different stakeholders. For example, the general public are often unaware of the signs and symptoms of AFib. Even when diagnosed, patients frequently decline therapy or have poor adherence to treatment often due to a lack of awareness or poor risk perception. Developing and supporting patient advocacy organisations may increase patient awareness of AFib, its complications and the need for appropriate treatment. 

  • Experts interviewed also reported that there is a dearth of knowledge about the burden of AFib among the medical fraternity outside of heart specialists, particularly with regards to the efficacy of anticoagulant therapies, as well as the appropriate referral pathway for patients with AFib. Interviewees also reported that awareness of treatment options, such as catheter ablation, is low among primary care doctors.

  • AFib-related hospitalisations are on the rise across the region. These increases are indicative of the pitfalls in AFib care. These include a lack of early intervention, suboptimal treatment as a result of inconsistent or variation in treatment strategies, poor disease management, and unsuccessful primary prevention efforts.
  • There is no universal consensus on the optimal screening mechanism for AFib, as evidenced by the diverse international recommendations on AFib screening. There is no standard protocol for AFib screening in China, India or Japan. Even in places where they do exist, such as Australia and South Korea, where single-lead ECG for screening for people aged ≥65 years is recommended, they are not implemented consistently in clinical practice. With the Asia Pacific Heart Rhythm Society’s recent publication of a three-tiered AFib screening recommendation structure, which takes into account different country characteristics, there is now a better framework for developing screening protocols in individual countries.

  • The application of digital health technologies is growing across a vast range of chronic NCDs and has great potential to enhance AFib screening. Large-scale studies in China and elsewhere have been using consumer smartwatches to screen people for AFib. Prof Guo, one of the experts interviewed as part of this research programme, led a study in China with 180,000 adults. Her team noted an abnormal heart rhythm in 0.23% of participants, and 87% of these were subsequently confirmed to have AFib – illustrating wearables' impressive ability to successfully identify people with AFib. While the experts interviewed were enthusiastic about the potential of digital health technologies for AFib, they also highlighted that referral pathways and medico-legal considerations with the use of wearables for screening need to be clearly delineated.

 

Given these insights, our research of AFib care pathways in five countries in the Asia-Pacific region has revealed six key policy takeaways:

 

 

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