The Importance of Managing Atrial Fibrillation (A-Fib) and Malpractice Claims for Failure to Do So

Atrial fibrillation is an irregular, rapid heart rate and can increase a person’s risk of a stroke 5 times.  It is the mismanagement of patients with atrial fibrillation that can result in serious harm to them, including death by stroke, and is usually the focus of malpractice claims in this area of medicine.

During atrial fibrillation, the heart’s two upper chambers (the atria) beat chaotically and irregularly — out of coordination with the two lower chambers (the ventricles) of the heart.  A normal heart rate ranges from 60 beats per minute – 100 beats per minute, whereas a person who is in afib has a heart rate ranging from 100 beats per minute to 175 beats per minute.  Symptoms include weakness, fatigue, reduced ability to exercise, heart palpitations, chest pain, lightheartedness, shortness of breath, and confusion.  Atrial fibrillation can occasionally come and go (called paroxysmal atrial fibrillation); be permanent, meaning it will not go away unless you receive treatment such as an electric shock or other types of medications; or be permanent meaning normal heart rate cannot be restored.

The reason atrial fibrillation can cause a stroke is this rapid, chaotic beating of the heart may cause blood to pool in your heart and result in a clot forming.  This blood clot can break off (this is called an embolus) and travel to, and block off, an artery leading to your brain.  This will block off the blood flow to your brain – which allows oxygen and nutrients to reach it – and will result in a stroke as brain cells die off.

It is because of this high risk of stroke and death that it is critical to properly manage someone with atrial fibrillation.  To do so it needs to be determined if you should be on anticoagulants (blood thinners).  Anticoagulants help prevent the formation of the clots that can block the arteries leading to your brain.  They can also cause brain bleeds though so your doctor has to weigh the risks and benefits of using them.

Today there is a standard scoring system that doctors use, and recommendations from various physician groups such as the American College of Cardiology, to determine the need for anticoagulation. The CHADS2 scoring system (Congestive heart failure, Hypertension, Age 75 +, Diabetes, prior Stroke) is the standard test used when evaluating stroke risk in afib patients. One point is given for every category except for prior stroke which is given a score of 2.

Someone having two risk factors and a score of two would be seen as a moderate risk of suffering a stroke and is generally recommended to be on anticoagulants.  However having suffered a prior stroke, regardless of other risk factors you may have, is considered the most powerful predictor of future strokes.  Therefore regardless of what type of atrial fibrillation you have – paroxysmal, persistent, or permanent, it is typically highly recommended you be on some kind of anticoagulant. If you are at a lower risk of stroke your doctor may put you on nothing or aspirin.

Besides the CHADS2 score there is an updated scoring system called the CHA₂DS₂-VASc Score (Congestive Heart Failure, Hypertension, Age 65 – 74, Age 75 +, diabetes, prior stroke, vascular disease, and sex) which takes into account more risk factors in determining your stroke risk.

The attorneys at the Thistle Law Firm are experienced in handling claims involving the mismanagement of a patient with atrial fibrillation.  Therefore if you or a family member suffered serious injury or death due to poor management of your or your family member’s atrial fibrillation the attorneys at the Thistle Law Firm are here to take your call at 215-568-6800 and discuss your legal options.

Leave a Comment