What is a Family Physician
Family medicine is a specialty that focuses on comprehensive primary care of people of all ages. Having a long-lasting relationship with a family doctor who knows your history is greatly beneficial. A family physician can diagnose and treat all types of diseases, and if necessary, refer you to a specialist. In treating patients a family physician can educate them on diabetes, obesity, immunizations, pregnancy, allergies, children’s health, mental health, men’s and women’s health and senior’s health.
Dr. Daniel Ngui, BSc (P.T), MD, CFPC, FCFP, Family Physician, talks about why it’s important for your family physician to help you manage atrial fibrillation and stroke prevention.
Managing Atrial Fibrillation and Stroke Prevention With Your Family Physician
Many patients come to their primary care provider to talk about atrial fibrillation. They often have some questions as to what it is, and how important is it, and how common is it?
Atrial fibrillation can be described as a condition in which your heart beats irregularly. When your heart beats irregularly, you can have clots form, which lead to stroke. You can have an irregular heartbeat which leads to heart failure, as well as it can lead to other complications involving the heart.
Atrial fibrillation can cause anywhere from 15-20% of strokes, and not only can they cause strokes, when you have an atrial fibrillation-related stroke, it leads to severe mortality. The rate of mortality is 25%, so one in four patients die. And not only that is six out of 10 patients, or 60% of patients who had an atrial fibrillation-related stroke, have a permanent disability.
When you have a conversation about medication options with your primary care provider, they’ll go through the whole gamut of options for you. In the past there was only one agent available, called Warfarin, but now the new agents called novel oral anticoagulants or direct oral anticoagulants that offer a number of advantages and possibilities.
For example, with Warfarin, it’s really important to take Warfarin on a regular basis, because having too much or too little leads to no protection or puts you at risk for bleeding. Number two is that with Warfarin you have to go for regular blood testing, which can be an inconvenience, a hassle and very painful for some patients.
With the direct oral anticoagulants, you do not need to have regular testing, but you need to take the medications regularly. The direct oral anticoagulants – there are many to choose from – have advantages, the main being that they’re safer.
The rate of intercranial bleeding, or bleeding on the brain, is much less than Warfarin, and that’s the main advantage. The direct oral anticoagulants have different nuances, some are once a day, some are twice a day, so speak to your primary care provider as to the best option for you.
Whatever choice you make, the most important thing is you take your medications regularly, every day, day in, day out. And speak to your primary care provider if you have any side effects, or any concerns about new medications, drug interactions, or potential changes to your medications because of what you hear or read on the internet or talk about with your colleagues.
When you do have that conversation about lifestyle factors when it comes to atrial fibrillation management, it would be important to do things such as quitting smoking or reduce your smoking if at all possible. Reducing or quitting drinking, because that can aggravate atrial fibrillation.
It’s important to incorporate regular aerobic exercise for 150 minutes a week as a minimum, as well as monitor your diet carefully, avoiding high fatty foods with saturated fats. Your primary care provider may help to refer you to a specialist to discuss atrial fibrillation.
The times in which you may need to see a specialist is when you have a complicated case of multiple comorbidities. For example, if you have heart failure and if you have atrial fibrillation and ischemic heart disease or blockages of the arteries, you may need to speak to a specialist about choosing the best combination of medications to protect yourself.
If you have any questions about atrial fibrillation management, don’t hesitate to speak to your family doctor or your primary care provider.
Presenter: Dr. Daniel Ngui, Family Doctor, Vancouver, BC
Local Practitioners: Family Doctor