If you know, you know....... unless you don't!

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Reducing stroke risk in our patients 

One of the simple tests that I liked to do with my new patients and then on subsequent reviews was to check that their pulse was regular.

If their pulse was irregular, it was quite likely that the patient had atrial fibrillation (AF). AF increases the risk to the patient of both stroke and heart failure (1). Not something that I wanted to happen to my patients. What is my job? To keep my patients alive, and functioning as well as possible!

The patients with an irregular pulse needed a cardiac assessment either by their GP or at the hospital. They would usually be prescribed an anticoagulant (2) or, if it got worse, would be referred for an ablation(3) where the electrical pathway in the heart is modified surgically.

This approach has been demonstrated to be effective in the treatment of AF and reducing stroke and heart failure risk (4).However, it doesn’t always work completely. Sometimes when discussing their AF, I would find myself being asked for lifestyle advice about reducing arythmia risk: do exercise (5), abstain from alcohol (6), and lose weight (7).

I would also advise them do reduce or abstain from caffeine. It is a commonly-held belief that caffeine increases arythmia. However this has been shown to not be true (8).In fact, drinking a cup of coffee daily seems to be helpful in reducing AF recurrence.

You don’t know what you don’t know…..

How do we try and counter this? How can we be the best practitioner to our patients? By keeping up with the latest research! The article (8) that stimulated this blogpost was published in JAMA Network Open (part of the Journal of the American Medical Association). It’s free to subscribe, and it arrives in my email inbox. I can very quickly scan it for articles of interest and relevance.

Kaizen: The practice of continuous improvement

Do you think that checking your patients pulse is a good idea? Let me know!

You might be interested in my Patient Management Course? Its free and can be found on my website here.

1. Vinter N, Cordsen P, Johnsen SP, Staerk L, Benjamin EJ, Frost L, et al. Temporal trends in lifetime risks of atrial fibrillation and its complications between 2000 and 2022: Danish, nationwide, population based cohort study. BMJ. 2024 Apr 17;385:e077209.

2. Ruff CT, Giugliano RP, Braunwald E, Hoffman EB, Deenadayalu N, Ezekowitz MD, et al. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. The Lancet. 2014 Mar;383(9921):955–62.

3. Kirchhof P, Camm AJ, Goette A, Brandes A, Eckardt L, Elvan A, et al. Early Rhythm-Control Therapy in Patients with Atrial Fibrillation. N Engl J Med. 2020 Oct;383(14):1305–16.

4. Osmancik P, Roubicek T, Havranek S, Chovancik J, Bulkova V, Herman D, et al. Catheter Ablation vs Lifestyle Modification With Antiarrhythmic Drugs to Treat Atrial Fibrillation. J Am Coll Cardiol. 2025 July;86(1):18–28.

5. Joglar JA, Chung MK, Armbruster AL, Benjamin EJ, Chyou JY, Cronin EM, et al. 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation. J Am Coll Cardiol. 2024 Jan;83(1):109–279.

6. Voskoboinik A, Kalman JM, De Silva A, Nicholls T, Costello B, Nanayakkara S, et al. Alcohol Abstinence in Drinkers with Atrial Fibrillation. N Engl J Med. 2020 Jan 2;382(1):20–8.

7. Abed HS, Wittert GA, Leong DP, Shirazi MG, Bahrami B, Middeldorp ME, et al. Effect of Weight Reduction and Cardiometabolic Risk Factor Management on Symptom Burden and Severity in Patients With Atrial Fibrillation: A Randomized Clinical Trial. JAMA. 2013 Nov 20;310(19):2050.

8. Wong CX, Cheung CC, Montenegro G, Oo HH, Peña IJ, Tang JJ, et al. Caffeinated Coffee Consumption or Abstinence to Reduce Atrial Fibrillation: The DECAF Randomized Clinical Trial. JAMA [Internet]. 2025 Nov 9 [cited 2025 Nov 10]; Available from: https://jamanetwork.com/journals/jama/fullarticle/2841253