Today
AF A
Issue 10, May 2013
Providing information, support and access to established, new or innovative treatments for atrial fibrillation
AF recognised as a health priority The AF Association has been heavily engaged with the Department of Health and we are delighted to inform you that as a result, AF is recognised as a priority within the Cardiovascular Outcomes Strategy (CVD strategy).
As a result, Sir Mike pledged that AF would now be included within the strategy. These recommendations were developed into a report, which was sent to the Secretary of State for Health and other key figures.
Historically, AF has not received the prominence it deserves in national policy, limiting the scope to improve patient care and drive AF expertise within the NHS. Indeed, the earlier National Service Framework for coronary disease failed to even mention AF, which is the leading cause of stroke.
Following this meeting, the AF Sir Mike Richards Association and a number of its members were invited to take part in the official review of the strategy, where we continued to make the case for AF.
This is a landmark achievement for the AF Association, who would like to thank all members and supporters for helping achieve this goal. What is the CVD Outcomes Strategy? The CVD strategy sets out, within cardiovascular provision, the quality of available services, the support patients will receive and the outcomes that should be achieved. The document is aimed at advising local authorities and NHS commissioners and providers about actions to improve cardiovascular disease outcomes.
AF within the strategy The AF Association welcomes the strategy highlighting the importance of improving the NHS focus on AF.
Specifically, it states that: “Despite there being incentives in the Quality and Outcomes Framework (QOF) and often clear evidence based guidelines (e.g. from NICE), people who have been diagnosed with or at risk of a CVD are not always optimally managed in primary care. For example, people who have atrial fibrillation are not always appropriately anticoagulated.”
AF Association in Parliament The AF Association operates the All Party-Parliamentary Group for Atrial Fibrillation (APGAF), which helps to raise the profile of AF among MPs and other key decision-makers. The group invited Professor Sir Mike Richards, who was leading on the development of the CVD strategy, to present at the APGAF meeting in April last year. Attendees discussed the implications for people with AF and recommended that it be included in national policy.
INSIDE
Ablation FAQs
Holiday tips
AF Association PO Box 6219 Shipston-on-Stour CV37 1NL ✆ +44 (0) 1789 451 837 @ info@afa.org.uk Registered Charity No: 1122442 AF-A ©2013
Inspiring stories
➚ www.afa.org.uk
The strategy also refers to providing people with timely access to treatment and ensuring that AF is identified earlier. Access to AF treatments has notoriously been limited despite the evidence showing that the longer a person has AF, the less likely they are to recover. Previous APGAF meetings have identified major causes of delays in receiving treatments, including: local prescribing guidance, lack of primary care awareness of updates and poor access to specialists. The strategy also assesses the costs and benefits of AF treatment, highlighting that improved uptake of drug therapy in prevention of AF-related strokes will result in fewer strokes and deaths. The strategy estimates that at least 2,100 lives could be saved and morbidity reduced by 7,100 strokes every year. Next steps The inclusion of AF in the strategy represents significant progress. However unless these recommendations are implemented they will be of limited value. The strategy does not make reference to the causes of, or solutions to overcoming obstacles to treatment. The AF Association has already responded seeking clarity on such important issues.
This was discussed at the most recent APGAF meeting and the group’s Chair, Glyn Davies MP, wrote to the Department of Health to reiterate the importance of prioritising AF in the NHS. We believe the CVD strategy is a step in the right direction but far greater detail is needed to secure equity of access to care and therapies across the UK.
Trudie Lobban MBE, CEO of the AF Association commented: “It is encouraging to see the Department of Health recognise AF as a priority, however it is imperative that it is followed up by action. The AF Association will continue to work alongside patients, healthcare professionals, commissioners and service providers to ensure early diagnosis and informed, appropriate management of AF patients, as identified in the strategy, becomes a reality within the NHS.’’
NICE review AF detection blood pressure monitor NICE has approved use of the WatchBP blood pressure monitor, recognising that it can be of considerable help when screening for raised blood pressure and the possible presence of AF. A total of 13 GP practices in Erewash, Derbyshire piloted a scheme using this monitor to screen over 65-year-olds during routine consultations as part of an AF detection initiative run by Erewash CCG (Clinical Commissioning Group). From June 2012 to January 2013 a total of 6,566 people (37% of the local over 65 years population) were screened, which resulted in 116 patients found to be in AF, giving an average increase of 7.7% of patients diagnosed with AF. Such a successful result will have helped to prevent eight AF-related strokes – saving misery and suffering for both the individual and their families, and an estimated £18,000 in NHS costs. You can learn more about the WatchBP monitor on the AF-A website: www.afa.org.uk
2
✆ +44 (0) 1789 451 837 @ info@afa.org.uk
➚ www.afa.org.uk
Stroke risk Why we remain at risk of AF related stroke Dr Matthew Fay is a GP with a special interest in AF. Here, he explains why so many people with AF remain at risk of AF related stroke. In AF, the heart’s top chambers, Dr Matt Fay GP with a or atria, stop special interest in AF contracting in an organised manner, causing an irregular heart rhythm. This can trigger palpitations, breathlessness, light-headedness or fatigue. Some people are asymptomatic or the symptoms mimic those expected from ageing. However, everyone with AF is at higher risk of stroke. Evidence proves the risk of AF-related stroke can be reduced by appropriate use of blood thinning drugs, or ‘anticoagulants’. These medications reduce stroke risk equal to people without AF. However, only half of people who would benefit from them, actually receive them.
The problem In AF, the atria stop contracting properly, which can cause blood clots. If these travel to the brain they
could block narrow blood vessels, starving the brain of oxygen and causing a stroke. There are various forms of clots. In AF the clots form slowly, similar to those in deep vein thrombosis.
Prevention At least 5,000 avoidable AF-related strokes occur in England every year because people are not effectively treated. While aspirin reduces the ‘stickiness’ of a clot, an anticoagulant makes it very difficult for clots to even form. For a long time warfarin was the main anticoagulation option. It is a very effective therapy, reducing risk by around 64%.
New oral anticoagulants In the past year, three new drugs have been approved by NICE (National Institute for health and Care Excellence). In clinical trials, they have proven to be at least as effective as warfarin but with lower bleed rates. Apixaban is the newest of the oral anticoagulants to be approved for non-valvular AF patients with one or more risk factor. Visit our website for more information and assess your personal risk score with the online AF risk calculator: www.afa.org.uk
New mobile device to detect AF A new smartphone tool to record pulse readings has been approved in the UK. The AliveCor Heart Monitor is an app and touch-sensitive cover for iPhone 4 and 4S, which can record, display, store and accurately transfer single-channel electrocardiogram(ECG) rhythms. These can be shared with healthcare professionals to help detect or monitor AF. An exclusive discount of £5 is available for AF Association members with voucher code ‘hrc2013a’ when you purchase the Heart Monitor on Amazon.
AF Association PO Box 6219 Shipston-on-Stour CV37 1NL
3
Inspiring stories
“No one should feel alone Paul Jaworski, a 57-year-old retired policeman, survived an AF-related stroke after being diagnosed with paroxysmal AF in January 2012.
“One night I went to take the rubbish out and I was aware I was getting out of breath to the point where I was actually finding it very hard to breathe. I had really intense pain in my back and shoulders and just didn’t feel right at all. “By the morning my heart had returned to normal rhythm but my wife and I decided it was time to get it checked out. By complete coincidence I went back into AF while I was in the waiting room at the doctor surgery. I was taken to hospital where I was finally officially diagnosed with AF.” Unfortunately for Paul his AF wouldn’t go away and his episodes became more frequent. What was supposed be an enjoyable cruise with his wife was ruined by AF and things started to get particularly bad.
“When I look back I knew I had AF for years” “When I look back I knew I had AF for years but it was something I just learned to live with,” recalls Paul. “I would get a racing heart and then as time went on I could feel it was irregular. But I would sit down and it would go away. It never really became a complete nuisance for me and it was very intermittent. I was probably having something like six attacks a year.” Realising he had a problem Paul searched his symptoms online and diagnosed himself with AF. But unaware of the need to be assessed for anticoagulation he began to take an aspirin every day in a bid to try and manage the disorder himself. “It wasn’t until January 2012 things started to get much worse,” Paul continues. “The episodes were becoming more frequent and AF was having a bigger impact on my life. I was getting really ticked off with it.
4
“In September 2012 things really came to a head,” he continues. “I had been to the gym and I was in the changing room when I went into AF and felt really rough. I managed to drive home and went to bed but when I woke up the next morning I was still in AF. Eventually my heart went back into sinus rhythm. “That night I was on my computer when suddenly I started getting all the symptoms of a stroke. It felt like sparks were going off in my head and then the whole right side of my body went numb and my speech went. “I got downstairs and my wife knew something was wrong immediately and called an ambulance.” Paul had suffered a transient ischaemic attack (TIA), or mini-stroke and was rushed to hospital.
✆ +44 (0) 1789 451 837 @ info@afa.org.uk
➚ www.afa.org.uk
with their AF” “I was so lucky because by the time I had got there I had already started to recover,” Paul said.
“It felt like sparks were going off in my head”
“Knowing the risk of stroke associated with AF and how strokes are often more debilitating I do feel very lucky and it still haunts me to this day. “I have since been put on the anticoagulant dabigatran and a higher dosage of flecainide and my episodes are a lot less frequent. But AF still has an impact on my life - psychologically it is a significant weight on your mind and you are constantly aware of it.” On living with AF Paul says: “It is very difficult and there have been times when I have been particularly bad when I couldn’t sleep and I have cried because I just felt so alone. “But I’m determined not to let it beat me or stop me in any way. I am keeping fit – in fact I have lost 8 stone since I first started to get my symptoms and I am still in the gym all the time. “My advice to anyone experiencing a similar situation to mine is - don’t feel alone. There are so many other people out there with this. At first it can seem like nobody can give you any information about AF.
“My advice to anyone experiencing a similar situation to mine is - don’t feel alone” “But I have found the AF Association’s support absolutely fantastic. It was so great to have a voice on the end of the telephone – someone to help me who knew all about the disorder and the treatments available.” Share your story with us. Email info@afa.org.uk
Tania’s story I was your average 36-year-old: I had an office job, smoked and went out most weekends. In the summer of 2009, I started feeling odd. At times, I was out of breath and on some days I struggled to walk. I put it down to carrying some extra weight and being a smoker. I found it difficult to concentrate at Tania Healy work and got tired easily. I began blacking-out in the office. Eventually I went to see the doctor, who transferred me by ambulance to the hospital. I was admitted and told the following day that I had a heart condition called atrial fibrillation. I burst into tears. I had never heard of it and thought that only older people had heart problems. I was put onto various medications, including warfarin. I am still taking flecainaide and verapamil, as well as warfarin. I have had a cardioversion, flecainaide infusion and a catheter ablation. My AF comes and goes and is usually stress related. I suffer from anxiety and depression for which I am receiving treatments. I have online friends who I have met via the AF Association forum and it helps to talk to others. It’s the tiredness that affects me more than anything. Tania Healy, Coventry
Introducing your new
patient services team! AF Association has been joined by two new patient services representatives – Vicki and Chris.
If you would like more information or support with your AF, please call patient services any time on 01789 451 837 or email info@afa.org.uk
AF Association PO Box 6219 Shipston-on-Stour CV37 1NL
5
Fundraise Baking our way to beating AF Take on the bakeathon challenge this Heart Rhythm Week to raise money for AF Association and raise awareness of AF. Order your free baking pack: 01789 451 826
3 - 9 June 2013
Around 1.5 million people in the UK have AF. Despite its prevalence, AF is frequently undetected and poorly managed. Please support us to help continue our work to change this. Support us without spending a penny!
Crunch your old car
Support the AF Association without spending a penny more! Shop online via Give as you live, Givingabit or Easy Fundraising and every time you shop, a donation will be made to the AF Association.
Exchange your old or unwanted car for cash as part of a free fundraising scheme run by Giveacar. Call 020 7736 4242, quoting ‘Atrial Fibrillation Association’ as your preferred charity.
Support us from your armchair Even from your armchair you can support us. All donations make a difference - £5 funds the out of hours phone lines for an evening, while £20 provides a pack of information for a GP surgery. No matter how big or small the donation, your donation will help shape the future for AF sufferers. To make a regular or one-off donation over the phone or by standing order please call 01789 451 837. Alternatively email fundraising@afa.org.uk To make a one-off donation via cheque, please make it payable to AF Association, and send to PO Box 6219, Stratford upon Avon, CV37 1NL.
Support us with a spring clean Are you having a spring clean? Why not donate your clothes through Charity Ecosystem? Charity Ecosystem will collect from your door and providing the clothing weigh 10kg or more a donation will be made to the AF Association. Call 0843 523 5313
Support to win! Join in with the AF Association annual raffle. Find a book of tickets enclosed. Tickets are just £1 each. Simply complete the ticket stubs and return them to AF Association, at the address below by 4 September 2013 and be in with a chance of winning £100! Additional raffle ticket books are available on request.
Our fantastic fundraisers! Special thanks to the Rollin Bones from West London, who took on an eight day cycle challenge from Hampton (London) to Avignon (France). Patrick Carew, Simon Bignall and Mike Conn, who have a combined age of 170 years, cycled more than 600 miles. They were supported by their friend Sean Fullerton, who had atrial flutter. Their amazing efforts raised over £4,000 – amazing!
Get active for AF From treks to swims, bike rides to coffee mornings there is something for everyone. Choose your challenge and your goal!
6
✆ +44 (0) 1789 451 837 @ info@afa.org.uk
➚ www.afa.org.uk
Patient power! AF Association asked to join review of vital AF treatment option following your feedback We asked for your support to campaign against a draft policy statement to restrict the commissioning of a very important treatment for AF patients – the left atrial appendage (LAAO).
What is the LAAO procedure? The LAAO procedure involves placing an umbrella like occlusion device over the part of the heart where the majority of clots form in AF patients – the left atrial appendage.
Following the high number of responses from patients, carers, healthcare professionals, MPs and service providers, to the Specialist National Commissioning Board (SNCB) regarding the published draft statement on commissioning for LAAO, the AF Association has been contacted by the Board and reassured that all responses received, whether online or by post, will be included in the planned review of this statement.
Once a patient’s left atrial appendage has been properly measured, a guide sheath (flexible tube) is inserted into a large vein in the groin and threaded up to the right atrium of the heart. It is then passed through a hole into the left atrium. The doctor then positions the guide sheath in the mouth of the left atrial appendage, and uses it to pass the occlusion device inside.
The SNCB will implement monitoring of local commissioning for implantation of the LAAO by assessing real-life referral and implant rates, equity of access, success and complication rates. The AF Association is invited to be part of the committee reviewing the proposal. Workshops will also take place to review the process of individuals responding to draft statements.
When the doctor is satisfied with the position of the occlusion device, it is released, plugging the appendage, and the sheath is then removed.
The AF Association welcomes commissioning which not only ensures important data is captured to be used in future commissioning, but also involves representation from patients and specialist clinicians who have first-hand experience of the LAAO procedure.
In trials and in practice the LAAO device has proven to be an effective option in reducing the risk of AF-related stroke in patients for whom an oral anticoagulant such as warfarin, dabigatran, rivaroxaban, or apixaban, is unsafe.
Thank you to everyone who shared their views!
Patient perspective
Lionel Leventhal,
Hertfordshire
Last year I suffered two TIAs within a couple of days. My cardiologist advised that I was a good candidate for the left atrial appendage occlusion procedure. I was in and out of the theatre room within a few hours and home the following day. I didn’t feel any pain or after effects. From my experience I would recommend this procedure for any suitable AF patient who is at risk of stroke.
I strongly believe information about LAAO should be more widely available for patients and even doctors.
AF Association PO Box 6219 Shipston-on-Stour CV37 1NL
7
All about catheter ablation - a procedure to treat AF with the aim to return the heart back to normal rhythm.
Consultant Cardiologist, Prof Richard Schilling answers your questions about catheter ablation What does the procedure involve? Initially the specialists will meet with the patient to talk through the procedure and assess whether this treatment might be beneficial for them. Through discussion and information, the patient and clinician can consider risks and benefits of the procedure. Several weeks beforehand a blood-thinning medication is initiated to prevent clots forming. Usually they arrive in hospital early on the day of the procedure. At the start, the person is sedated and an ultra-sound scan of the heart is conducted to make sure everything is normal before we start the procedure. A local anaesthetic is then used at the top of the leg where the wires are introduced and we start the procedure, which normally lasts around three hours. Usually the person stays overnight for monitoring and assessment, with a further ECG test before discharge.
What are the risks? Many of the risks involve minor problems which resolve on their own. These include mild bruising at the top of the leg, chest discomfort for a few days after the procedure and occasionally instances of recurrent AF which settle down as the heart heals. More important risks include blood leaking out of the heart during the procedure which occurs in a very small number of patients. In these cases the blood is drained off with a needle and the patient may need to stay in hospital for a couple of nights while this settles down. This happens because we use anti-blood clotting drugs during the procedure which then make the blood more likely to leak. We do this to try and reduce the risk of stroke, but the procedure still has a risk of stroke which is about 0.4%.
How long before I can return to normal? Once a patient is discharged we will advise them to take it easy for a couple of weeks before they return to normal exercise and activity. We are usually happy for them to return to desk jobs after a week and patients shouldn’t drive for a week after the procedure.
8
What are the success rates? The results of catheter ablation vary enormously between patients. Patients most likely to have success from the procedure are those that have paroxysmal AF and those without other heart disease. Patients who have persistent AF tend to have lower success rates. The reason for this is that there tends to be more tissue which supports the AF and the ablation required is more extensive. The longer you have the disorder, the more tissue becomes supportive of AF. So the chances of ablation working for someone who has had AF for more than three years is very much lower than patients who have had AF for less time.
Can I stop taking my medication? Many patients ask us what drugs they can stop after the procedure. If ablation is successful most patients will be able to stop antiarrhythmic medication. However, there is no evidence to show that ablation reduces stroke. So for patients at high risk of stroke, whether we think the ablation has been a success or not, we recommend they continue appropriate stroke prevention. If patients are not at high risk of stroke, then after they have been through the three month post-op healing process we are happy for them to stop their anticoagulation.
Will it improve my life? The important thing to remember about ablation is the main indication for doing the procedure is symptoms persisting despite the patient being on rate and/or rhythm controlling medication. For those patients the difference can be dramatic because the symptoms destroy their normal quality of life and stop them from doing everyday things. If successful, ablation can transform these patients’ lives. However, for patients without symptoms the procedure is unlikely to have a profound impact on their life.
✆ +44 (0) 1789 451 837 @ info@afa.org.uk
➚ www.afa.org.uk
Paul’s catheter ablation My AF was getting worse and the interval between the attacks were getting shorter. I was feeling very unwell. So after six months of seeing my electrophysiologist at John Radcliffe Infirmary Hospital, he suggested I should get catheter ablation done. After the treatment, I felt better. But soon after when I returned home from hospital, I started feeling atrial flutter, by which I mean the pulse was very fast but not irregular, like AF. I saw my EP again and he prescribed sotalol to abort the attacks, and also suggested I should try another ablation. He was quite confident it would significantly improve how I would feel, so I jumped for it! After the second ablation, I felt a huge difference from the very beginning. I can’t tell you how good it felt. I never had any problem. I was very, very happy.
Dr Paul Bose
“Now I am doing everything that I want to do”
Within four to six months, I got enough confidence to do a little bit more harder work. And now I am doing everything I want to do.
Top 10 tips to manage your AF on holiday 1 Take more medication with you than is required in your hand luggage in case of travel delays or loss
2 Carry a list of medications and doses 3 Tell airport security about any implants. Don’t go through metal detectors because they may interfere with your device. Ask to be frisked manually
4 Get up and stretch your legs while travelling to reduce the risk of blood clots forming
5 Do anti-DVT exercises at least every half an hour. Raise your heels, keeping your toes on the floor, then bring them down again. Do this 10 times. Then raise and lower your toes 10 times
6 7
Carry water to counter the effects of dehydration
8 9
Wear your flight socks throughout the flight
10
Wear loose comfortable clothes
Drink alcohol in moderation or cut out altogether, and avoid sleeping pills Take advice on how to take medication if on long haul flights with significant time changes
For more information including what to do before your holiday visit www.afa.org.uk/patient-information/travel
AF Association PO Box 6219 Shipston-on-Stour CV37 1NL
9
Like us?
@AtrialFibUK
Getting Social
The AF Association’s online community continues to grow from strength to strength! Here are snippets some of discussions you have been having on our online forums: Pregnancy and AF What would happen if you have AF and got pregnant... could you come off all meds and manage a pregnancy?
Every pregnancy is different but the emphasis is on healthy mum = healthy baby. I went med-free for my first pregnancy and did really well. Apart from them commenting on an irregular pulse during my emergency C-section, I was fine.
Pregnancy number two was a completely different kettle of fish. The arrhythmias were unmanageable from week 5 of pregnancy and I was pretty much bed bound. It’s definitely something to discuss with the doctor before pregnancy.
“The forum is a place where nobody with AF needs to feel alone. Ask a question about AF and somebody will have been there before and can share their experience. A few of us have been around almost since the first day and still try to offer advice and support.” Bob
“The Yahoo group has been my saviour and has kept me going at some very low points when the AF was bad. Now I am able to offer support and love to other people. I have made life-long friends and their kindness and care keeps me going I have been blessed to meet them.” Kirsten
Erectile dysfunction
I have erectile dysfunction (ED) and I first I too suffer from ED; have done for probably noticed this shortly after being diagnosed with AF. 8 years now. What came first, the AF or the ED? There hasn’t been a total shutdown - only for very short No idea. I was only diagnosed with AF in periods. I think my ED is linked to my AF diagnosis. December 2012; I have probably had it for all eight years. Are there any men with AF who have I know that if you go to the doctor with ED, they will nearly experienced ED? always do an ECG as AF and ED are so common together. But what causes what? My advice; firstly and most importantly bring your wife into the decision-making, discussion and above all treatment of the ED, you need her full support, and with it you can find alternatives or even treatments that will work. Talk to your GP as well. There are lots and lots of treatments now.
I’ve been through the same issues. Initially I had also been diagnosed as diabetic. The ED is partly attributed to the drugs prescribed for heart conditions. MY GP changed my atenolol (which is thought to aggravate ED) to nebivolol which has helped. I’ve also been told that ramipril (which I’m still taking) also has a negative effect.
Join in the discussion on either of our forums; afassociation.healthunlocked.com or health.groups.yahoo.com/group/A-F-A/ Internet shy? Join us at Patients Day instead. See page 11 for more information
10
✆ +44 (0) 1789 451 837 @ info@afa.org.uk
➚ www.afa.org.uk
2013 AF Patients’ Day AF A
Sunday 20 October at The ICC, Birmingham, UK Join AF Association at its popular AF Patient Day Agenda topics include: Diagnosed with AF: care & management Symptomatic AF: drug options Ablation outcomes Diagnosed, assessed and treated… but what future can I expect?
“Being able to meet and talk evaporated my feeling of isolation” Joan P
Supporting recovery The ‘new NHS’ Afternoon workshops and discussion to include: exercise, drug options, lifestyle considerations For more information please email info@afa.org.uk or call +44 (0)1789 451 837
“Listening to people who knew about AF answered many of my worries and queries” Alan J
Early bird registration at Patients’ Day is £20 (until 31st July 2013) and £30 thereafter. Registration on the day is £50. To register please complete the form and return with payment to the AF Association (address at foot of page) Registration Form
Address:
Full Name: Telephone: Email:
Postcode:
Please tick the box whether you are:
Patient
Carer
Other
Payment Details Please select your payment method below Credit/Debit Card: Please call +44 (0)1789 451 837 to pay over the phone Cheque: Make payable to ‘Atrial Fibrillation Association’.
AF Association PO Box 6219 Shipston-on-Stour CV37 1NL
11
3-9 June 2013 Join hundreds of supporters across the UK to raise awareness of AF. There are many ways to get involved in Heart Rhythm Week!
1. 2. 3. 4.
Share information with your friends and family Display information in your local medical centre, nursery, hospital or leisure centre Raise funds or donate to AF Association Share your story - Heart Rhythm Week generates a lot of media interest. Fill out the form below to share your story.
Contact Pippa Mawle for more information: pippa@heartrhythmcharity.org.uk or telephone 01789 451833
Tell us your AF story. You never know who it could support. Many people ask us if their experiences are unique. They are always eager to hear about someone who has been through similar challenges on their path to diagnosis or when finding the right course of treatment. Please complete the form below: 1. How did you discover you had AF? ............................................................................................................................... 2. If you experienced symptoms, how long was it between being first aware of the symptoms and being diagnosed with AF? ...................................................................................................................................................................... 3. What treatments have you received? Oral anticoagulation (blood thinning medication) ................................................................................................... Other Medication – please specify .......................................................................................................................... Ablation
Pacemaker
Cardioversion
Left atrial appendage occlusion
Any other treatment – please specify....................................................................................................................... 4. If you experienced difficulty accessing any treatment please share this with us ........................................................... 5. Has any treatment caused you to feel more unwell? .................................................................................................. 6. Have you experienced a stroke or TIA?
No
Yes - TIA
7. Are you happy to participate in requests from journalists to feature in the news? Your name
Yes -stroke Yes
No
The year you were born
Daytime contact telephone number (including area code) Please return completed forms to the AF Association. Do include any extra information on a separate sheet; we would welcome receiving a photograph of you to accompany your experience. Your help will assist us to inform and support other AF patients.
12
AF Association PO Box 6219 Shipston-on-Stour CV37 1NL ✆ +44 (0) 1789 451 837 @ Email: info@afa.org.uk