Recently Diagnosed or Relapsed? Stop Looking For a Miracle Cure, and Use Evidence-Based Therapies To Enhance Your Treatment and Prolong Your Remission
Multiple Myeloma an incurable disease, but I have spent the last 25 years in remission using a blend of conventional oncology and evidence-based nutrition, supplementation, and lifestyle therapies from peer-reviewed studies that your oncologist probably hasn't told you about.
Click the orange button to the right to learn more about what you can start doing today.
- You are here:
- Home »
- Blog »
- Multiple Myeloma »
- Treatment-induced Atrial Fibrillation?
Treatment-induced Atrial Fibrillation?
What is the untreated stroke risk of treatment-induced atrial fibrillation aka Afib? I was diagnosed with chemotherapy-induced cardiomyopathy more than 15 years after administration of known cardiotoxic chemotherapy regimens for the treatment of multiple myeloma.
So this information is important to me.
Anyone suffering from treatment-induced cardiovascular disease, hypertension, atrial fibrillation, etc. should read the article below and ask themselves if the medications that their cardiologists have been prescribing for them for years, are based on the same sort of “evidence-based” evidence that John M. Mandrola, MD, author of the article below, is talking about when he writes about the stroke risk from AF.
I ask people to question their heart medications for the simple reason that I have managed my
- Chemotherapy-induced hypertension
- Chemotherapy-induced atrial fibrillation
- and chemotherapy-induced cardiomyopathy
all with evidence-based NON-conventional therapies. I have been getting an annual echo to track all of my heart metrics. And these annual echos tell me that all of my challenges are stable.
A cardiologist who treats the whole patient! Wonderful-
Do you have treatment-induced atrial fibrillation? Email me at David.PeopleBeatingCancer@gmail.com with questions.
Thank you,
David Emerson
- MM Survivor
- MM Cancer Coach
- Director PeopleBeatingCancer
Do We Really Know the Stroke Risk From AF?
One of the most interesting trends in modern cardiology is the reversal of dogmas. Routine beta-blockers after myocardial infarction may no longer be needed despite being established practice for years.
The net benefit of oral anticoagulation in patients with atrial fibrillation (AF) may be another area of reversal. Central to this may be new knowledge about untreated stroke risk in patients with AF.
Declining Risk for Stroke in Untreated AF
There is growing evidence that the risk for stroke in patients with untreated AF is declining. And that the risk is a lot lower than predicted by the widely accepted CHA2DS2–VASc score. Recall that the use of anticoagulation (with warfarin) in patients with AF was established in trials conducted more than 30 years ago…
Despite mean CHA2DS2VASc scores of 4 in enrolled patients, stroke rates in the placebo arms of these trials were approximately 1% per year. That’s 75% less than what the CHA2DS2VASc score predicts…
One explanation for this discrepancy is that short-duration AF (1-3 hours) detected on a monitor is a different entity from symptomatic AF confirmed on a standard ECG. Both involve fibrillatory activity of the atrium but the former (subclinical AF) clearly confers a lower stroke risk than the latter (clinical AF)…
In patients with heart failure due to reduced ejection fraction, sudden arrhythmic death has declined over time as medical therapy has improved. Why couldn’t stroke risk in AF follow a similar pattern given better management of risk factors, improved air quality, et cetera?
Finnish Observational Registry Study
A recent study using data from the Finnish national registry suggests exactly that…
There were three main findings:
- The age and risk profile of those diagnosed with AF increased over time. The mean age went from 70 to 73 years, and the CHA2DS2VASc score from 3 to 3.5 comparing the earliest group to the latest one.
- Despite the worsening risk profile, the overall rate of ischemic stroke decreased by 25%. Absolute rates went from 36.7 to 27.6 events per 1000 patient-years. The decrease was mostly driven by a 32% decline in stroke rates in women vs a 7% reduction in men.
- Most of the decrease occurred in older women with higher stroke risk scores. The rate of ischemic stroke in patients with a CHA2DS2-VA score of 1 (excluding sex) remained stable at approximately 8.2 per 1000 patient-years…
Implications for Interventions and Quality Metrics
Although the study was carefully done, it was observational and retrospective. We should be cautious in its interpretation.
Yet its main strength is that these real-world data comport with those of recent trials, which also show unexpectedly low stroke rates.
These observations don’t tell us who or who not to treat with oral anticoagulation. Those are individual decisions that require judgement and alignment with a patient’s values. The Finnish observations suggest that one reason the placebo group stroke rates in recent trials were far lower than predicted by risk scores is because the population stroke risk is lower…
Taken together, this evidence should reinvigorate our skepticism about knowing stroke rates in untreated AF. I write “reinvigorate” because we should have always been humble about stroke prediction in patients with AF.
We widely accept guideline recommendations and quality measures regarding risk-based oral anticoagulation. In doing so, CHA2DS2-VASc has morphed into something akin to mathematical truth…
Finally, the most important conclusion to make is that the evidence that guides practice should have an expiration date. In addition to studying new therapies, we should also study old therapies and dogmas. As technology advances, base rates of bad outcomes of disease change. This surely affects net benefit. We need to have the humility to accept equipoise and do new trials…
treatment-induced atrial fibrillation treatment-induced atrial fibrillation treatment-induced atrial fibrillation