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Atrial fibrillation

Reducing stroke risk through other medication and lifestyle changes after diagnosis of atrial fibrillation

Alongside anticoagulant (blood thinning) medication, people with atrial fibrillation (AF) can help reduce their stroke risk by managing hypertension and cholesterol and leading a healthy lifestyle. We asked people to tell us what they did.

Managing hypertension and cholesterol with medication
As well as medications to control heart rate and rhythm and anticoagulants to thin the blood, people with AF may also be on blood pressure medication such as candesartan, ramipril, frusemide, amlopidine, bisoprolol, and atenolol, and/or statins such as simvastatin and atorvastatin to help keep arteries clear, reduce cholesterol and minimise their risk of stroke. Elisabeth X, who is in her seventies, said, ‘it’s fairly standard for somebody of my age who’s got a heart thing’ to be on blood pressure medication. Statins have helped David Y get his high cholesterol ‘under control’, while taking simvastin to keep his cholesterol level down has helped Chris Y ‘live with’ his AF. Some people are taking statins even if their cholesterol is not high. Keith was prescribed simvastin after his TIA/minor stroke, and Ann takes simvastin, as ‘a precaution’. 

While people we spoke to recognised the benefits of these medications, they also spoke of side effects. Glyn takes a cholesterol tablet every night even though they give him ‘horrible nightmares and a dry mouth’. As he put it, ‘if it stops you having a heart attack or keeps your arteries clear, it’s well worth going through that’.
 

Eileen described the difficulties of trying to balance blood pressure drugs with medication for her AF.

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Age at interview: 63
Sex: Female
Age at diagnosis: 53
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I was admitted I think over the weekend and, just a general medical side and they changed my atenolol to bisoprolol. And, basically, it stopped on its own again and they sent me home. Now, I didn’t know it but I don’t like bisoprolol and oh, it was awful. I was tired. I was breathless. I was down in the dumps. I’d got no appetite. I really couldn’t be bothered to do anything. 

I went to see [consultant] and explained to him what was going on. The first thing he said to me was, “Do you know what the side effects of bisoprolol are?” And I said, “No.” So he rattled off every one of my symptoms. So the first thing they did was took me off the bisoprolol and put me back on the atenolol but by then, my blood pressure, which is not easily controlled at the best of times was haywire. So then we had three months of actually controlling the blood pressure.
 

James found that his cholesterol medication gave him arthritis-type symptoms in his wrists.

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Age at interview: 63
Sex: Male
Age at diagnosis: 59
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Well, I’m on warfarin, I’m on pills for my blood pressure, candesartan, and I was on cholesterol pills. Cholesterol pills gave me arthritis type feelings in my wrists, which was, it took some finding out what it was but that was I had cortisone injections. That didn’t do any good. I think it was they looked on the side effects on all the pills and discovered that it could it could cause that, so I stopped taking it, now it’s cleared up. I was having trouble even holding the steering wheel, which meant I was going to have to pack up work, which didn’t really please me.

Okay. So are you are you on anything for your cholesterol now?

I just take natural sterols, and watch what I eat, and I’m going to have another cholesterol test in a couple of weeks.
 

Freda experienced skin problems after taking simvastatin to control her cholesterol.

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Age at interview: 70
Sex: Female
Age at diagnosis: 68
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I am on statin. I take rosuvastatin, five milligram for to control my cholesterol level, because although I we have a very good diet but I my make-up, genetic make-up is such that is incapable of controlling, you know, eliminating extra fatty acids, so, therefore, I was told to take this. Before I came to a super-statin, I was given a… the simvastatin, ten milligram or something like that and then, which I came out with spots on my face, with acne, you know, acne like spots, which did not disappear for months, very hard red spots which hurt, for months. My GP said, “Oh, it’s nothing to worry about.” But I knew it was a reaction to the simvastatin. I demanded that he gave me a different kind of a statin. He gave me atorvastatin, again I came up with spots. I came up with the spots on my face. I came up with spots on my buttocks. I had huge acne on my buttocks and the doctor gave me this rosuvastatin. 

Then I deliberately didn’t take rosuvastatin until this acne disappeared because I wanted to give the rosuvastatin a clear, you know, chance to react on me and I didn’t have any spots but a tiny, tiny acne appeared on my face but I decided I’d better carry on with this, see how I get on. Fortunately, it seems to me that there wasn’t any further acne to come up and nowhere else on my body. So I continued to take this rosuvastatin. I’m on this for about four years or so. 

On reading and studying that the, on, not sort of, you know, I what you can get from the internet, the statin is famously notorious for affecting the muscles like legs etcetera etcetera.
Leading a healthy life with AF
People we interviewed were aware of the need to adopt a healthy lifestyle as a way of reducing their risk of stroke.
 

Noel is conscious of the risk of stroke and monitors what he eats and drinks.

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Age at interview: 62
Sex: Male
Age at diagnosis: 60
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And the stroke fear I don’t think about it every night, but a lot. That really does pray on my mind a lot, stroke, fear of stroke is the big thing. So if I have, if I indulge too much on a glass of wine or if I eat a dessert or, you know, something with fat in it more than normal, I head home going, “Oh my god.” I’ve got to watch my cholesterol level here. I’ve got to watch my blood pressure. All of that, it’s a fear of stroke. And if I meet someone who’s had a stroke, I’ll think about it all of the next day. In fact, I’m seeing someone tomorrow night who has had a stroke [tapping] and when I first met him I was very, very aware about having strokes. The fear of stroke is does affect me and can cause depressive moments.
Many commented on how exercise and eating a low fat ‘healthy’ diet with plenty of fruit and vegetables were already part of their everyday lives. James said he was careful of his cholesterol intake and had cut down on alcohol. As Jeni commented ‘I haven’t really changed very much – I had a healthy diet and led a boringly healthy life anyway’. Recent warnings about the increased health risks associated with eating too much red meat had encouraged some people to include more chicken, fish and vegetables in their diet. Glyn tries to eat as much white meat and oily fish as he can to minimise his risk of stroke.
 

Suzy has made few changes to her diet but has cut down her use of chillies and given up chocolate.

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Age at interview: 49
Sex: Female
Age at diagnosis: 48
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When I was first diagnosed, I was asking my specialist, you know, “What can I do? Tell me, if there’s anything, any lifestyle factor, I’ll change them immediately. I’m very motivated about these things.” And he was saying, “Suzy, you’re not doing anything bad.” And I said, “I suppose I’m not a bungee-jumping banker am I?” And he said, “No, above all you’re not a boozing banker.”

So I drink herb teas and water and don’t really want for anything else. Other lifestyle factors, I really, really love very spicy food. I love chillies and there is a school of thought that says that maybe even very spicy food could trigger AF in people who are sensitive. I, it certainly turns up the heart rate. I haven’t given up chillies but I’ve probably cut down just a little bit, because I just haven’t wanted to rock, rock the boat of not being in AF. But it would be very difficult for me to give up on spicy food but maybe there’s no need. Chocolate I’ve given up actually, just in case.
 

Alongside taking medication for her AF, Pauline makes sure that she eats a healthy diet.

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Age at interview: 69
Sex: Female
Age at diagnosis: 65
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No, I haven’t tried any alternative treatment other than what the cardiologist has recommended. I wouldn’t stop that, ever. I’d be too afraid to stop that, but I do make sure that what we have to eat you know, is healthy, make sure we have enough fruit and things like that and don’t eat, I only have one thin scraping of butter a day on my toast in the morning, big treat [laughs]. That’s it. Then it’s the Benecol, you know, the cholesterol free stuff. And I only have one cup of coffee a day and that’s in the morning. Make sure I drink plenty. Don’t have a lot of strong tea. Anything so I don’t get the palpitation or anything that would aggravate it.
 
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George X leads a healthy life which includes eating well and regular exercise.

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Age at interview: 78
Sex: Male
Age at diagnosis: 63
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Well, yeah, I mean apparently I’m doing everything I should do. We don’t cook with salt. We don’t have any salt. The only time we do, we have lo-salt, which [wife] uses when she mashes potatoes. She doesn’t like it other than that. We have that Benecol low fat stuff. Fibrous food for breakfast. Well, not much else I can do I think, everything is sort of, I make sure everything is going okay, yeah. I’m not overweight. I walk from all over the place and I enjoy walking.
In many cases, people had cut down or given up caffeinated tea and coffee and/or alcohol after finding they triggered palpitations. Bob believed that it was an enzyme or yeast rather than alcohol that triggered his AF, as he still had symptoms drinking alcohol-free beer. Chris X found that chocolate, and MSG (monosodium glutamate) in Chinese food triggered his AF. George Y now avoids eating bananas after finding they triggered his AF. Geoff cut out wheat and found this dramatically improved his AF symptoms. Keith gave up smoking and drank less after he had a TIA/minor stroke. The stroke ‘did the trick’ as he had steadfastly ignored his doctor’s advice before this.
 

Despite keeping a food diary, Freda has not found anything that triggers her palpitations.

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Age at interview: 70
Sex: Female
Age at diagnosis: 68
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I don’t get unduly worried in the middle of the night when I get I get woken up with the palpitation, which is does happen. Sometimes it goes on for a long, long time. Sometimes it’s just a minute or so. It makes me wonder why the behaviour of my palpitation differs like that, and I decided to take the food diary it’s about a year ago and they, what I have for breakfast, when I have my breakfast, what I had for evening meal, what I drank for in between for my refreshments etcetera, etcetera. To start with I decided to cut down on any kind of caffeinated, drinks with the caffeine such as tea and coffee. When I’m desperate for coffee I do have, I allow myself one decaffeinated coffee a day but on holiday, it’s, where decaffeinated coffee is not available, I end up doing, drinking ordinary coffee but it doesn’t seem to affect unduly. That’s what I noticed. 

With regard to food diary, I have not come across any particular vegetable, any particular dish or anything like that appears to affect, not that I have any sort of varied diet. 

Over a year of food diary, I have no nothing to tell myself that I would be careful with this. Neither on caffeinated drinks either but I have noticed that the lack of sleep, lack of exercise, exercises, suddenly a lack of exercise, it doesn’t give me a very good sleep. I tend to wake up during the night. So perhaps disturbed sleep, it may be something to do with a lack of lack of exercise. 
 

Nuala explained how giving up alcohol had a knock-on effect on her social life.

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Age at interview: 60
Sex: Female
Age at diagnosis: 48
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My alcohol consumption has greatly reduced and when I look back on it now, I probably was taking far too much but I wasn’t aware of it at the time. But I was forced to because alcohol would have been another thing that would have would have messed with your AF. So for a time, I just stopped drinking and it was a very different time because we would have gone out on a regular basis at the weekend and for a meal and had wine. And so all that stopped and that was difficult because it was a big change in my lifestyle. Then I wouldn’t have, because I was so afraid of going into AF I wouldn’t I wouldn’t have had any alcohol at all and that was a change for me, big change, but probably not a bad change. And saying that, now that I am in AF I would have a drink but not extremely and I would be very aware of my alcohol intake and I think it has done me the power of good not taking. 

I’m much more aware of it now. It was difficult, very difficult at the time because you were on a lifestyle and I really, really wanted my type I wanted my life back again, the way I had it and it wasn’t going to happen. And it was, when I look at it through, it was very much a grieving process for the life that I had, denial at first, and then really angry and really frustrated at not being able to do what I wanted to do and particularly, going out socialising, even though I went out but I was the one that was sitting that wasn’t drinking.

So in a way, some things, as I say, it’s one of the worst things that has happened to me but it’s one of the best things that’s happened to me. It’s forced me to look at my life.
 

Despite being fit and leading a healthy lifestyle, Noel finds AF a depressing illness. He believes nothing can be done to cure it.

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Age at interview: 62
Sex: Male
Age at diagnosis: 60
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I’ve found that AF is actually, although I’m coping with it, I found it quite a depressing illness for, because there’s basically nothing that I can do to make it better. For example, if you’re overweight and you have a, you know, problem with your heart, not a serious problem with your heart but, you know, you’re overweight. The doctor will say, and you’ve got high blood pressure, the doctor will say, “Cut out the cigarettes, cut out the smoking.” Sorry, “Cut out smoking, cut out cigarettes, cut out the alcohol or cut it back, eat less fat, be more aware of your cholesterol levels and your heart will get better.” And that doesn’t happen with AF. You can be the fittest person on the planet and lots of athletes have AF. In fact, it can cause AF apparently, so there’s nothing I can do to fix my AF. There are things I can do to help control the palpitations perhaps, but there’s nothing to cure it unless I, unless by some miracle it reverses itself but it won’t because as, as all consultants say, “AF begets AF begets AF.” There’s a big slogan that that the logo that seemed to appear all over the place, “AF begets AF”
Some people we spoke to made few changes to existing fitness programmes. They continued to walk, swim and go to the gym as they had done before their diagnosis. For others, a diagnosis of AF led to a commitment to exercise more, or to adjust their exercise routine. Janet reported feeling ‘a lot fitter and a lot better in myself’ after investing in a personal trainer and regular exercise.
 

Since his TIA/minor stroke, Chris Y has adjusted his exercise routine.

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Age at interview: 64
Sex: Male
Age at diagnosis: 62
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Well, I discussed at some length, actually, sort of exercise with my GP and said that I’ve always been I’ve always played a lot of sport and, you know, like to like to sort of keep active and, you know, the TIA happened after I’d been out jogging and I was got cold and all the rest of it. And, you know, he suggested, you know, things like swimming, very good. I do enjoy swimming. I don’t go swimming as often as I’d like to but I do like swimming and I find that a very sort of therapeutic sport anyway. And we discussed walking rather, it’s not really a stroll that I do. It’s quite a vigorous walk, you know. It makes your, the heart is working, you know, over what it would normally do. I do about four, four and a third miles an hour, which is, you know, quite a brisk walk. But exercise, as I say, is something I did discuss and swimming and walking were the two that we thought would be best sort of thing, because I can do it regularly, particularly now I’m retired. I, you now, I can do that anytime.
People told us that losing weight was an important part of a healthy lifestyle and would help minimise their risk of diabetes and stroke. Paul spoke of undertaking a ‘lifestyle change’ with his wife and losing weight: ‘I was trying to do something positive because of the AF’. Dot decided to ‘lose some weight’ and gain a sense of control over her AF. Others tried to get more sleep. Freda noticed that lack of sleep affected her AF. Some tried to slow down and manage stress.
 

Elisabeth Y realised she had to eat more healthily and lose weight or risk developing type 2 diabetes.

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Age at interview: 69
Sex: Female
Age at diagnosis: 63
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Well, my fasting blood sugar got, no, it was glucose tolerance test, got so high that I was just zero point five off being a type two diabetic and I was eating like a pig, eating ordinary good food and then stuffing myself with sweets and cakes and all sorts and I thought, “[Elisabeth], you’re going to have to do something about this.” And I came home, keyed into Google diets for type two diabetes, and there was one that really was just so different and so paradoxical that I’ve been on it ever since, high fat, high protein, low carbohydrate, cut out all the white things, you know, rice and bread and sugar and all this. 

I lost the weight in about six months. This is the bit that’s annoying me, my weight has settled at thirteen stone and doesn’t go down. The other half of the trick is portion control. 
Despite good intentions and an awareness of the importance of adopting a healthy lifestyle ‘when you’ve got AF’, some people found that this was not always easy. Mary, a woman in her eighties, described how ‘ready meals came in handy’ despite her desire for a healthier diet; Raymond, while adopting the message of ‘five a day’, was confused about quantities: ‘Is one little sliver of carrot a portion of carrot?’ Janet spoke of the difficulty of losing weight: ‘I’ve cut down on carbohydrates but my weight doesn’t seem to shift’; Vera was trying to lose weight, but found that an increased appetite which she attributed to taking prednisolone for another condition, hindered her weight loss efforts. Raymond, who recently had surgery for knee and spinal problems, expressed concern that he would put on weight through lack of exercise.
 

Dave described his exercise dilemma.

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Age at interview: 61
Sex: Male
Age at diagnosis: 50
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And so again, if I exert myself for any length of time then or I tend not to exert myself for any length of time these days anyway. I run for buses occasionally and then it takes, it can take about five minutes before my breath goes back to normal. But I don’t go out of my way to exercise anymore because I was told not to exercise too much but not, it’s one of those funny things, you’re told not to stop exercising but don’t overdo it and trying to get that balance right is sometimes can be a bit difficult. So instead I go cycling, I walk but I don’t do any, I don’t run unless I unless I have to, like running for a bus.
 

Carin is afraid to exercise in case it triggers an attack. She wishes she could be more active.

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Age at interview: 62
Sex: Female
Age at diagnosis: 55
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I was much more active, well, I was, in those two years, one year, one and a half years that I didn’t, I was really getting much more active than I had been and, of course, I have a weight problem and, you know, sitting around is not good. So it very much affects me that way [sniffs] that’s, you know, I’d like to get active again like I was, but I’m I fear, I fear that I’d run into troubles. So…

I used to go to the gym. I used to go to the gym like every now three four times a week. I daren’t go there anymore. So, you know, and people say, you know, my nurse, the nurse that I’ve seen says, “Oh, just go to the gym.” And I say, “Yeah, well, what happens when I’m there and I get one of these attacks?” She says, “Well, you just stop, you know. You stop, you stop moving.” 

What I would like to see happen is that there is more understanding of this condition and maybe, for people like myself, I need to go to the gym you know, maybe there’s, there should be some supervised gym, you know, properly supervised by a cardio-nurse or whatever. You know, so medical people there, that when you get this, that they’re there and they can sort of help you through, because at my gym there’s nobody there. It’s unsupervised.
(For more see ‘Atrial fibrillation, stroke risk and blood thinning medication’ and ‘Heart rate and rhythm medication for atrial fibrillation’).
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