Presented by Dimy Doresca, Director of the Institute for International Business, Tippie College of Business, University of Iowa

For people with atrial fibrillation (Afib), the fear of having a stroke is very real. Afib raises a person's risk for stroke five times, according to the National Stroke Association. It's a scary statistic, especially as Afib prevalence continues to rise. Understanding the connection between Afib and stroke can help patients better manage their condition and recognize other factors that could put them at even greater risk.

"A stroke prevention strategy of some kind is required for anyone with Afib, no matter how many symptoms you have or how many risk factors you have," said J. David Burkhardt, MD, electrophysiologist at the Texas Cardiac Arrhythmia Institute at St. David's Medical Center in Austin.

Afib occurs when the heart's upper chambers (atria), which push blood to the lower chambers (ventricles), beat irregularly. "Instead of the blood being pushed forward by the heart pumping, it's just swirling around in the heart and can clot easily," said Marcie Berger, MD, FACC, a cardiac electrophysiologist at Froedtert Memorial Lutheran Hospital and the Medical College of Wisconsin in Milwaukee. Clots can travel and cut off blood flow to the brain, causing a stroke.

Besides an irregular heartbeat, a person with Afib "can have additional risk factors making a stroke even more likely," said Dr. Berger.

Most doctors use a tool known as the CHADS2 score to evaluate patients' stroke risk based on the following criteria:

• Congestive heart failure. Heart failure occurs when blood isn't being pumped efficiently to the rest of the body, resulting in fluid retention and congestion. If the heart isn't pumping at full capacity, the risk of clotting increases. "Diminished heart function is a risk factor for Afib itself as well as stroke, and it's more common in older patients," said Dr. Burkhardt.
• High blood pressure. When the force of blood against the arteries is too high, it can cause damage to the arteries over time. "It becomes a double whammy, where you have high blood pressure as well as atrial fibrillation increasing your stroke risk," said Ralph L. Sacco, MD, professor and chairman of neurology at the Miller School of Medicine at the University of Miami.
• Age: 75 or older. The median age among people with Afib is 67 years old in men and 75 years old in women, according to the U.S. Centers for Disease Control and Prevention. "In older adults, a new Afib diagnosis is usually due to age-related changes in the electrical system of the heart," said Dr. Berger. Changes in the heart and blood vessels are common with age, and reduced circulation increases the risk of blood clots forming.
• Diabetes. People with diabetes are nearly four times more likely to have a stroke, according to the National Stroke Association. People with uncontrolled diabetes are more prone to have high cholesterol, and plaque build-up in the arteries can block blood flow to the brain.
• Stroke or transient ischemic attack. Someone who's had a stroke is many times more likely to have another than someone who's never had one. According to the American Heart Association, a person who's had one or more TIAs, or "mini-strokes," is 10 times more likely to suffer a stroke.

The American Academy of Neurology recently issued an updated guideline recommending oral anticoagulants, or blood thinners, to prevent stroke in Afib patients. Guideline lead author Antonio Culebras, MD, of SUNY Upstate Medical University in Syracuse, NY, noted, however, that "doctors will need to consider the individual patient's situation in making a decision whether or not to use anticoagulants, and which one to use, as the risks and benefits can vary for each person."

Some stroke risk factors, such as age and family history, can't be controlled. But, "if we can address those controllable factors earlier in the disease process, hopefully we can work to reverse this growing trend," said J. Brian DeVille, MD, FACC, FHRS, medical director of electrophysiology at Baylor Health Care System in Dallas.

Many of the same lifestyle changes that help manage Afib can also reduce stroke risk, such as maintaining a healthy weight, exercising, and quitting smoking. The key is coming up with a prevention plan that a patient can commit to for the long run.

As Burkhardt points out, "once you're diagnosed with Afib, stroke prevention is a consideration forever."

Rock Island, IL: The Rock Island Public Library's Main Branch at 401 19th Street, will be closed to the public starting at noon on Thursday, Nov. 13 in order to transform the library into a star-studded stage for "Lights, Camera . . . Literacy!"

The Food for Thought fundraiser is an annual event hosted by the Rock Island Public Library Foundation, as a means of both raising awareness of the Foundation and of raising funds for special projects and improvements at all three libraries in Rock Island. Lights, Camera . . . Literacy!" offers guests a walk down the red carpet with food from guest chefs, complimentary beverages, musical entertainment by the Edgar Crockett Duo and Lee Blackmon, just for fun magic, palm and tarot card readings by donation, and bidding on a variety of silent auction items. The event is from 5:00 pm to 7:30 pm at Rock Island Main Library, 401 19th Street.

Guests get the Main Library to themselves for a night of socializing and dining around food stations on the first and second floors. The selections include dishes from:

• Eudell Watts, III, of  Eudell's Specialty Foods - Thai Lettuce Wrap
• Martha Cleveland of  Blue Cat Brew Pub - Cakes and other desserts
• Annette Zapolis, of  Cool Beanz Coffee House-  Olives, flatbreads, cookie bars, brownies, coffee and more.
• Kitchen Express, a program of the Thurgood Marshall Learning Center -  Hoisin Steak Rolls, Caramel Brownie Bites, and a Spicy Red Pepper Jelly/Lemon Goat Cheese Cracker
• Chef Craig Joos, HyVee of Rock Island- Hot pasta dish
• Chef Jose Zepeda of  QC Coffee & Pancake House - Chef Jose's #1 Seller, Homemade Corned Beef Hash. Special Recipe Hand-Made Sausage Links, Biscuits & Gravy and a Rock Island Favorite, Orange Grand Marnier Pancakes.
• Main Street Catering (Rock Island Holiday Inn) - Mini desserts

Also on the menu are complimentary soda, water , coffee, wine tastings from wine retailer Thad Miller, and beer tastings from Dan Cleaveland, the brew master for Blue Cat Brew Pub. Food and complimentary beverages are included in admission. Just for fun tarot card and palm readings will be available on a donation basis by Lady Cassandra, advisor to the stars, with walk-around magic provided by the "Great Matthew."

A wide variety of silent auction items will also be available for bidding. Packages include auctions for a window cleaning service for up to 25 windows, a truckload of firewood to keep cozy all winter, an outdoor fire pit donated by Crawford Company, restaurant baskets, and handmade arts and crafts. Literary-themed baskets include a Christmas book and quilt from Joy Murphy, a book and DVD set of "The Roosevelts," "My Little Pony" graphic novels, and an Eric Carle The Very Hungry Caterpillar poster, board book, and hand-sewn felt caterpillar "food."

Guests who RSVP in advance receive preferred admission of $35 per person. To RSVP, please call 309-732-7326 or email riplfoundation@gmail.com by 5:00 pm on Nov. 11. Walk-in admission without an advance RSVP is available at $40 per person. Admission is payable by cash, check or credit at the door.

While the Main Library will be closed after noon on Nov. 13, both the Rock Island 30/31 and Southwest Branches will be open for patrons with library needs, as will the library's online branch services at www.rockislandlibrary.org. For more information, visit the library website or call 309-732-READ.

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