A former Wales rugby captain-turned GP is helping tackle a heart related medical condition that can lead to the most serious form of stroke.
Dr Gwyn Jones, who played for Cardiff RFC and captained his country in the late 1990s before injury cut short his blossoming career, is part of a taskforce put together to detect and treat atrial fibrillation (AF) – the most common form of abnormal heart rhythm.
It can affect adults of any age, but it is more common as we get older.
Dr Jones is juggling his role as a GP partner in the Estuary Group Practice in Swansea with working alongside fellow clinicians in Swansea Bay University Health Board to raise awareness of AF and establish four new community-based clinics which specialise in detecting and treating the condition.
The work is funded by Welsh Government and is being carried out in conjunction with neighbouring Cwm Taf Morgannwg and Hywel Dda university health boards.
Dr Jones said:
“It is the most common abnormal heart rhythm and tends to happen in people as they get older. The vast majority who get it are beyond 60, but you can get it at any age.
“It causes your heart to beat irregularly and, often, too fast.
“We think there around 80,000 people in Wales who have AF but we know there’s probably another 10 to 15%, who we don’t know about, on top of that.”
There are several common symptoms but some people display none at all.
Dr Jones said:
“People who feel an irregular pulse may get palpitations – that sensation of the heart beating abnormally.
“Other people may feel breathless as the heart is not getting the oxygen around the system quite well enough. Some may feel light headed or dizzy, and some people might get some swelling of the legs associated with it.
“Some people get absolutely no symptoms at all. People may well have AF and be completely unaware of it.”
AF commonly occurs when a strain is put on the heart.
Dr Jones said:
“Like all things, it’s a bit genetic and a bit environmental but the main cause is anything that puts a bit of a strain on the heart.
“But things like diabetes, high blood pressure, and other heart problems would place an added strain on the heart and that might cause the electrics not to work quite properly and then people develop this abnormal heart rhythm.”
Dr Jones warned the main concern around AF is it increases your risk of stroke – especially if you have some risks factors already.
He said:
“We know that there are people out there with AF that we should be diagnosing and if we can diagnose them early then we can reduce the chances of them having that stroke.
“The thing that makes it a bit of a concern is the strokes that people get with AF tend to be at the worst end of strokes. They are not your mild strokes. They’re the ones that are much more likely to cause death or disability.
“That’s why it’s so important to try and find them early.”
Treatment has improved over the years and involves thinning the blood.
Dr Jones said:
“If you do have AF the most important thing is to thin the blood with one of these new anticoagulants that are very effective at reducing the risk of a stroke.
“We understand a lot more about the way we can thin the blood in a safe way now.
“We used to use warfarin but we have better drugs now – ones that don’t interfere with foods and don’t need the same level of blood tests – that thin the blood as good as or, if not, even better than warfarin did.
“They are much more like an aspirin than warfarin used to be.”
The good news is AF is easily diagnosed.
Dr Jones added:
“Anyone who feels their own pulse and it’s not regular – if it’s a bit fast or a bit slow, that’s fine, but when it comes in a chaotic or random way and you can’t predict when the next beat might be, then that’s an irregular pulse and we want to check that to make sure it’s not AF.
“If someone has concerns because they have palpitations or felt an irregular pulse then they should get an electrocardiogram (ECG) done with their GP surgery – it’s as simple as that.
“They will be able to tell them straight away whether an ECG shows AF or not.
“There are some people- but it’s rare – who get AF that comes and goes. That might have episodes of palpitations and then that disappears.”
Part of the money provide by Welsh Government has been used to improve detection rates.
Dr Jones said:
“We’ve done a few things. We’ve given GP surgeries these little Alivecor devices.
“If someone’s having palpitations or you think they may have AF, all you have to do is put your fingers on either side of the silver electrodes and it will send a signal to your smart phone to do your ECG so we can see what your heart rhythm is.
“We’ve given them out to GP surgeries, to pharmacists, to heart failure nurses, and podiatrists – anyone who is checking on people, especially if they are older or have cardiovascular disease already.
“You can check a pulse – if that’s regular it virtually excludes AF – but if you’re not sure you can use one of these devices.
“They’re a pretty neat bit of kit.”
Community clinics have also been set up – in Penclawdd, Killay, Gorseinon and Port Talbot – to help GPs with the more difficult diagnoses.
Dr Jones continued:
“If you are not 100% sure, you can be referred to our community clinics and we can do further testing.
“They are GP led. There are three GPs who can do cardiology-type things to investigate and diagnose AF if there’s any uncertainty from your GP. Especially for those people who might get AF that comes and goes. For some people we may want to put an ECG on for 24 hours. Some people may need an additional test, a scan of the heart, which we have also got funding for.”
Dr Jones, who many will recognise as a current rugby pundit on television, isn’t the only former Welsh rugby captain to be knowledgeable of AF with Wales’s record cap holder, Alun Wyn Jones, being diagnosed as having the condition towards the end of his career.
Dr Jones said:
“Alun Wyn Jones has revealed recently that he had AF just at the end of his career. His fitness targets weren’t quite as good as they used to be and it wasn’t until he had a proper medical that they found that he had an irregular pulse and his heart was racing a bit.
“Athletes are prone to it because they put a strain on their heart through the exercise that they do. Especially triathletes – they put a lot of strain on their systems.
“He’s gone on to have a procedure to fix that – you don’t really need to do that unless you’re an elite athlete or it’s giving you lots of trouble – and he’s now an ambassador for these devices.”
Swansea Bay University Health Board’s Interim Executive Medical Director, Anjula Mehta, welcomed the work.
She said:
“This work is an important Value Based Healthcare initiative to improve the public’s awareness of signs and symptoms of atrial fibrillation, to allow earliest detection of this disease and facilitate prompt access for our patients to seek help from expert health care professionals.
“Undiagnosed and untreated atrial fibrillation can lead to serious and debilitating consequences such as a stroke. To prevent these complications it is important to ensure an early diagnosis is made and patients are started on the best available treatment of blood thinning medication.
“To this effect, Dr Jones and the VBHC project team have worked closely with Cardiology, GP and Swansea University colleagues to improve and enhance our current clinical pathways, it really has been a team effort.
“Since commencing this improvement work we have seen an increase in the number of patients with a new diagnosis of atrial fibrillation in Swansea Bay which shows more patients are seeking early help for their symptoms.
“We have also seen a 3% increase in patients with known AF who have been reviewed and started on blood thinning medication.
“I am grateful for Dr Jones’ clinical leadership and to all colleagues who have contributed to improve care and outcomes for AF patients in Swansea Bay.”
