1. © 2014, Russell Research All rights reserved. AF Survey Executive Summary A U G U S T 2 0 1 4

2. Physicians

3. 2 A majority of physicians believe most Atrial Fibrillation patients don’t usually understand their increased risk of stroke and feel most patients underestimate the impact ischemic stroke can have on their lives. Virtually all physicians (97%) agree that AFib-related ischemic stroke can have devastating outcomes. More than one-half of physicians (55%) indicate their typical Atrial Fibrillation patient does not usually understand their risk of ischemic stroke due to Atrial Fibrillation. Nine in ten physicians (90%) believe that many Atrial Fibrillation patients underestimate the impact an AFib-related stroke could have on their everyday lives. Four in five physicians (79%) believe many AFib patients are in denial about their risk of experiencing an ischemic stroke.

4. 3 Physicians (Cont’d.) Reducing the risk of Atrial Fibrillation-related ischemic stroke is almost always the primary objective when prescribing anticoagulation therapy. A variety of compliance barriers exist, and typically vary by specialty. More than four in five physicians (85%) indicate their primary objective when prescribing anticoagulation therapy to patients with Atrial Fibrillation is to reduce the risk of AFib-related ischemic strokes. However, bleeding (65%) and the overall safety profile of medication (62%) are leading concerns when prescribing anticoagulation therapy. Additionally, three in five Neurologists (62%) identify minimizing the risk of hemorrhagic stroke as a primary concern. Four in five physicians (79%) believe too many patients underestimate the importance of adhering to their prescribed therapy for reducing the risk of AFib-related ischemic stroke. Risk of bleeding is the largest compliance barrier for Electrophysiologists (35%) and Cardiologists (31%), while monitoring anti-coagulation effect is the most common barrier for Neurologists (53%) and General Practitioners (36%).

5. 4 Physicians (Cont’d.) Physicians typically initiate conversations about the increased risk of AFib- related stroke and treatment. They see a variety of barriers to educating patients about their condition and seek support as they try to provide counsel. Nine in every ten conversations (90%) between physicians and patients about increased risk of AFib-related stroke and available treatments are initiated by physicians. Other than personally discussing their situation with patients (87% discuss condition, 82% to discuss treatment), there are no other widely used methods of patient education. Written materials are used by one-half of physicians (52%) for information on the condition, and less than one-half use them to educate about treatment options (45%). In these discussions, the two most widely perceived barriers to educating Atrial Fibrillation patients is that they believe once their symptoms are being treated, the risk of AFib-related stroke goes away (43%) and patients feeling that the risks outweigh the benefits for medications reducing the risk of AFib-related stroke (41%). More than four in five physicians (83%) wish they had more information/educational materials to share with their Atrial Fibrillation patients that discuss stroke risk associated with Atrial Fibrillation. In terms of specific materials, three in four physicians (76%) would like to have educational brochures, pamphlets, or posters as resources to discuss stroke risk and treatment options with their Atrial Fibrillation patients and caregivers, and more than two in five (44%) would like web-based illustrations/animation.

6. 5 Physicians (Cont’d.) Further, many physicians believe their colleagues are not doing enough to educate patients about the risk of ischemic stroke in Atrial Fibrillation patients and urge their peers to be mindful of the risk. Three in four physicians (76%) regularly advise or remind their colleagues of the increased risk for ischemic stroke among Atrial Fibrillation patients. Two in three physicians (67%) feel many of their colleagues don't do enough to educate Atrial Fibrillation patients about the risks of AFib-related ischemic strokes.

7. Atrial Fibrillation Patients

8. 7 The impact of Atrial Fibrillation and related stroke can be devastating, with a majority of survivors not even diagnosed prior to experiencing a stroke. Survivors wish they had known more about stroke, as there is a widely held belief that experiencing a stroke was worse than they could have imagined. Three in five survivors (61%) did not know they suffered from Atrial Fibrillation prior to experiencing a stroke. Only one-third of stroke survivors who spoke with their physician about Atrial Fibrillation (35%) discussed the impact of AFib-related stroke on everyday life. Five in six stroke survivors (83%) wish they had known more about reducing the risk of an AFib-related stroke prior to experiencing a stroke. More than three in four stroke survivors (77%) indicate their life has not been the same since experiencing an AFib-related stroke, and nearly three in four (73%) agree that experiencing a stroke was worse than they had imagined. Although two-fifths of survivors don’t go out as much since having a stroke (40%) and have experienced depression (39%), three in five (60%) have attempted to live healthier lives.

9. 8 Atrial Fibrillation Patients Meanwhile, an alarming percentage of Atrial Fibrillation-only patients are not aware of nor understand the differences between different types of stroke, and couldn’t recognize the symptoms if one were to occur. Less than one-half of Atrial Fibrillation-only patients (45%) are aware there are different stroke types, and less than two-fifths (38%) are familiar with ischemic stroke. When provided with a description, less then three in ten (28%) identified an obstruction within a blood vessel supplying blood to the brain as ischemic stroke. One-third of Atrial Fibrillation-only patients (32%) don’t believe they would be able to describe the most common symptoms of stroke.

10. 9 Atrial Fibrillation Patients Most patients will eventually have a discussion with their physician about the increased risk of ischemic stroke, however many important issues are left out of conversation. More than four in five Atrial Fibrillation patients (85%) have had a discussion with their physician about the increased risk of stroke due to Atrial Fibrillation. However, more than one-third of patients (36%) were not initially informed by their physician that they may be at an increased risk of stroke. Additionally, only two-thirds of AFib-only patients (65%) and less than one-half of survivors (48%) have discussed the risk of AFib-related stroke with and without medication. On average, patients who have discussed the issue with their patients indicate they initiate the conversation 47% of the time – far different than reported by physicians (10%).

11. 10 Atrial Fibrillation Patients Atrial Fibrillation patients are eager for information about how to reduce their personal risk of ischemic stroke. Despite this eagerness, many are not receiving materials that could provide further education. Five in six AFib-only patients (87%) will seek to find out everything they can about Atrial Fibrillation and reducing their risk of AFib-related stroke. More than four in five of all Atrial Fibrillation patients (82%) would be interested in learning more about how to reduce their risk of AFib-related ischemic stroke. Less than one-half of patients (48%) indicate their physician gave them written materials to read regarding Atrial Fibrillation and the increased risk of AFib-related stroke. Four in five AFib-only patients (80%) would like to have more information to take charge of their Atrial Fibrillation and learn about reducing the risk of AFib-related stroke.

12. 11 Atrial Fibrillation Patients There are a wide range of important facts about Atrial Fibrillation-related stroke that are unknown to a relatively high percentage of patients. More than two in three Atrial Fibrillation patients (68%) were not previously aware that AFib-related strokes are nearly twice as likely to be fatal or disabling as non-AFib-related strokes. More than one-third of Atrial Fibrillation patients (36%) were not previously aware that you can have 5 times greater risk for stroke if you are living with untreated Atrial Fibrillation. Less than three in ten Atrial Fibrillation patients (27%) believed women had a higher risk of Atrial Fibrillation-related stroke than men.

13. 12 Atrial Fibrillation Patients Despite a lack of information, a high percentage of patients have taken medication and are compliant. Six in seven patients who have discussed Atrial Fibrillation-related stroke with their physician (87%) have taken medication to reduce their risk of stroke. Oral anticoagulants (72%) are most commonly prescribed. More than nine in ten patients who have taken medication (92%) regularly take their prescribed treatment to reduce their risk of AFib-related stroke. Two in five patients who discussed an increased stroke risk with physicians (39%) named using a treatment that reduces the risk of a stroke caused by a blood clot in the brain to be the most important quality, and three in five (59%) named it as one of their two most important qualities. Motor limitations are of primary concern in experiencing a stroke – one- third of patients (32%), including two-fifths of AFib-only patients (40%), indicated losing the ability to move, talk, or some other physical function concerns them most about having a stroke.

14. Caregivers

15. 14 Caregivers Caregivers tend to provide assistance and care for stroke survivors who are in “worse shape” than the average survivor. On average, caregivers are providing assistance to survivors during 47% of their everyday activities. Survivors that were interviewed had indicated they required assistance 12% of the time, with three-fifths (61%) not requiring any assistance at all. One in seven caregivers (14%) provide assistance 100% of the time survivors are doing everyday activities, and one in two (50%) provide assistance at least half of the time survivors are doing everyday activities. The survivors in their care are more likely to have experienced a range of limitations: 92% experienced motor limitations within their first 6 months, compared to 81% of the overall survivor population 94% of these survivors still experience motor limitations, compared to 80% of the overall population 81% experienced cognitive limitations within their first 6 months, compared to 52% of the overall survivor population 69% experienced sensory limitations within their first 6 months, compared to 54% of the overall survivor population 43% experienced vision limitations within their first 6 months, compared to 31% of the overall survivor population

16. 15 Caregivers This situation places a crushing burden on caregivers which impacts personal time, relationships and emotions. More than nine in ten caregivers (92%) feel they have a lot more responsibilities since becoming a caregiver. Nine in ten caregivers (91%) agree that their lives have not been the same since the person in their care experienced an AFib-related stroke. Six in seven caregivers (86%) couldn’t have imagined the amount of work it takes to care for a stroke survivor. Two in three caregivers (66%) don’t have as much time to do activities or hobbies that bring them joy. Three in five caregivers (60%) feel like they have more to do than they can handle. More than two in three caregivers (68%) feel their relationship is different with their patient since they suffered a stroke. Nearly three in five caregivers (56%) feel more socially isolated.

17. 16 Caregivers Despite this burden, caregivers are dedicated to assisting the survivor in their care and stay informed about Atrial Fibrillation and associated stroke risks, including being an active participant in the survivor’s medical care. Most of these caregivers are knowledgeable about ischemic stroke. Nearly nine in ten caregivers (86%) indicated they were aware there were different types of strokes. Three in four caregivers (76%) are familiar with ischemic stroke, and two-fifths are very familiar. Additionally, more than two in three caregivers (68%) were able to correctly identify an ischemic stroke as being caused by an obstruction within a blood vessel supplying blood to the brain. Four in five caregivers (82%) accompany the survivor in their care to doctor’s appointments always or most of the time. More than three in four caregivers who attend doctor visits (78%) indicate the survivor’s physician has directly discussed Atrial Fibrillation and the increased risk of stroke, and more than three-fifths of caregivers (62%) have themselves discussed the increased risk of stroke due to Atrial Fibrillation with the physician. On average, caregivers indicated more than three in four (78%) conversations about treatments to reduce the risk of Atrial Fibrillation related stroke are initiated by the physician. This is more in line with what physicians have reported (90% of conversations) compared to Atrial Fibrillation patients (53%).

18. 17 Caregivers A majority of caregivers have not received written information from physicians and have been forced to search for it on their own. This has led to most caregivers reporting that they would have liked to had more information. After the survivor in their care was diagnosed with Atrial Fibrillation, four in five caregivers (81%) tried to find out everything they could about it and reducing AFib-related stroke risk. Less than two in five caregivers who attend doctor visits (38%) indicate physicians have given written materials to read regarding Atrial Fibrillation or the increased risk of AFib-related stroke. Seven in ten caregivers (69%) have personally sought out information related to Atrial Fibrillation or AFib-related strokes. Of caregivers who have researched Atrial Fibrillation, more than three-quarters (77%) obtained information from an association or website related specifically to heart conditions or AFib-related stroke and a slight majority (54%) looked at written materials. Nine in ten caregivers (89%) would have liked to have had more information about Atrial Fibrillation and learned more about AFib-related stroke.

19. 18 Caregivers Beyond information, many caregivers indicate they could benefit from various types of other assistance. Five in six caregivers (83%) wish they had more support and information to take care of the survivor in their care. Seven out of ten caregivers (70%) would find physical help useful in helping provide care. More than three in five caregivers would find home modifications (63%), financial assistance (63%) and respite care (62%) useful in helping provide care.