Hi guys,

Today I wanted to do a video on the subject of Risk in atrial fibrillation. Most people understand that there is an increased risk of stroke in atrial fibrillation but truthfully very few people really understand this concept of risk and not uncommonly when I speak with patients about anticoagulation, they say well I feel alright at the moment so can I not just see how thing go and I wanted to do a video to try and explain this concept of risk.

Risk is defined as the probability of something harmful happening. So the first thing to understand is that there is very little relationship between how you feel and what your future risk is.

Have a look at this diagram. Here is a man who is just leaving home to go walk to work. There is a manhole on his way to work.

There is little relationship between how he is feeling as he says bye to his family and whether or not he will fall into the manhole and therefore it is a mistake to confuse how you feel with your risk.

A person with daily migraines may feel awful all the time but may live till they are 90. A person with a brain tumour may not feel anything at all and have a great quality of life but may die within a few weeks or months.

So when you are contemplating any treatment it is very important to understand what medications are being prescribed for your quality of life and what medications are prescribed to reduce your risk and not to confuse how you feel with your risk.

None can tell you exactly what your risk is of anything. However, it is possible to study a population of people just like you and work out the risk of that population by following them up and seeing how many people suffer harm over a set period of time and from that it is possible to give you some sort of idea as to what your risk is.

What controls the size of the manhole in atrial fibrillation: Age and as you are getting older every year the manhole will get bigger too every year comorbidities such as Diabetes, high blood pressure, heart failure, and vascular disease. Atrial fibrillation itself doesn’t probably make the manhole bigger..rather atrial fibrillation is probably like a hazard sign alerting everyone to pay attention to the manhole. We know this because patients with atrial fibrillation who are young -less than 65 and who don’t have any comorbidities have a very low risk, but people who have comorbidities even without Afib have a much higher risk so in essence the Afib is a marker rather than a cause of increased risk and this is why it doesn’t matter if the Afib is present or not, the manhole still exists and is always going to get bigger because the size of the manhole increases as age increases.

There are only 2 things that you can do about the increasing size of the manhole You can reduce significantly the size at which it is getting bigger by paying attention to lifestyle. You can partially cover the manhole by taking anticoagulants – 60% – Anticoagulants will not affect hw you feel..they simply work by reducing your risk. Aspirin will only cover it by 20% at most – unfortunately the bigger the manhole, the thicker the manhole cover and then there is a risk that you could trip over the manhole cover and bleed So in essence here are the main messages:

Do not confuse how you feel with your risk is governed by your age and comorbidities and not by the presence or absence of AF Your risk can only ever go up and therefore there really is no merit in waiting Anticoagulants will reduce your risk by 60% but carry their own risks Lifestyle modification is always worthwhile because it will not only stop your risk from increasing but has no side effects and will also make you feel better.