JANUARY 20, 2017 BY MOLLY SKUBAK

Cohort Update: Atrial Fibrillation

Between 2.7 and 6.1 million Americans have atrial fibrillation, the most common heart rhythm abnormality. Atrial fibrillation, or AF, occurs when the normal, organized electrical signals that typically control heart contractions are replaced with chaotic waves of electrical activity in the top heart chambers. While some people with AF don’t notice any symptoms, many experience racing heart rates, irregular heartbeats, fatigue, shortness of breath, mild chest tightness, or lightheadedness. Beyond these discomforts, AF also significantly increases the risk of heart attack and stroke.

Common treatment options for atrial fibrillation include medications that keep the heart from beating too fast, or that help it beat with a regular rhythm. Other atrial fibrillation medications are anticoagulants, which thin the blood to prevent stroke. The optimal selection and dosing of all of these treatment options could benefit from further research. For instance, Warfarin, a common anticoagulant, is often prescribed to reduce the risk of stroke, but it can be difficult to manage because it requires frequent lab monitoring.

Given AF’s high prevalence and continued need for research, the PaTH Network made atrial fibrillation one of its three primary areas of focus. Led by Dr. Saman Nazarian of Johns Hopkins Medicine, the AF research team is taking a closer look at the following questions that patients with atrial fibrillation often have:

1. If I have an ablation procedure – which targets small areas of heart tissue thatpotentiate an abnormal heart rhythm – what are the chances I will go back to the hospital due to complications after the procedure?
2. My doctor tells me about different approaches to controlling my heart rhythm; which one is least likely to affect my memory and thinking?
3. I do not have time to get the frequent blood work required for Warfarin therapy. Would one of the anticoagulants advertised on television be better for me and, if so, which one?

The atrial fibrillation cohort has been collecting survey data from patients with AF over the past 12 months. Each survey participant is asked to complete surveys at three time-points: baseline, six months, and 12 months. The 12-month surveys are currently underway. The survey addresses patients’ quality of life, their adherence to anticoagulants, and more, says Dr. Nazarian.

PaTH informatics experts are pulling data for the AF cohort and adding elements from the patients’ electronic health record data. These data include patients’ EKG rhythms, ventricular rate, atrial rate, and more.

"We’re looking forward to getting the data," says Dr. Nazarian. "I think answers to these questions will be very helpful to patients."

The AF cohort is also contributing to the development of PaTH’s data infrastructure. AF data will be used as a test case for SHRINE+ software. PaTH uses Shrine+ to identify which patients’ data should be included in a specific analysis and to request data for relevant patients from each PaTH site. Each site’s IT team can run the a SHRINE+ “query” in that site’s local database and examine the resulting data before approving or rejecting the request. If approved, the data are then transferred to the University of Pittsburgh’s secure Health Services Research Data Center for analysis.

Researchers with the cohort are also working on multiple manuscripts, addressing topics such as the effects of heart rhythm medications on thought and memory function and identifying patients who may be at high risk for bleeding and stroke if they take blood thinning medications.

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