Atrial Fibrillation

Atrial Fibrillation: Symptoms, Risks, and Stroke Prevention
Why AF matters more than you think — and what you can do about it
About This Guide
A Clear, Honest Guide to Living Well with AF
Who This Is For
Whether you've just been diagnosed with atrial fibrillation or you've been managing it for years, this guide is written for you — and for the family members and friends who support you. We've drawn on the latest Australian and international evidence to give you a clear picture of what AF is, why it matters, and what you can do.
Our goal is simple: empower you with knowledge so you can have better conversations with your doctor and take an active role in your own care.
What You'll Learn
01
What AF is and how it feels
02
Why stroke risk is the key concern
03
How medications and lifestyle help
04
Practical steps you can take today
Section 1
What Is Atrial Fibrillation?
Atrial fibrillation — often called AF or AFib — is the most common heart rhythm problem in adults. If you have AF, your heart's upper chambers (the atria) are beating irregularly and often too fast. Instead of contracting in a steady, coordinated way, they quiver or "fibrillate."
Think of it like this: normally, your heart beats in a smooth, regular rhythm — like a drummer keeping perfect time. With AF, that rhythm becomes chaotic and unpredictable. The electrical signals that coordinate each heartbeat become disorganised, firing rapidly and erratically across the atria.
AF is surprisingly common in Australia, especially as we get older. More than 300,000 Australians aged 55 and over are estimated to have AF — and this number is expected to double by 2034. If you've been diagnosed with AF, you are far from alone, and there is a great deal we can do to help you stay healthy and active.
300K+
Australians with AF
Aged 55 and over currently living with the condition
2034
Expected to Double
The number of people with AF is projected to double within this decade
Section 2
What Does AF Feel Like?
People experience AF in very different ways. Some feel it strongly; others not at all. Recognising the range of symptoms — including the possibility of having none — is an important first step.
Palpitations
A racing, fluttering, or skipping sensation in the chest — the feeling that your heart is beating irregularly or pounding.
Fatigue
Unusual tiredness or weakness, even during activities that normally feel easy. Energy levels can drop significantly when the heart isn't pumping efficiently.
Breathlessness
Feeling short of breath, especially with physical activity or exertion. Some people notice this even when resting.
Dizziness
Feeling lightheaded or dizzy, which can occur when the heart's output drops during an AF episode.
Chest Discomfort
A feeling of tightness, pressure, or general discomfort in the chest. Always tell your doctor about chest symptoms.
AF Can Be Silent
Between 10% and 40% of people with AF have no symptoms at all. Their AF is discovered during a routine check-up, on a smartwatch, or sometimes only after a complication occurs. This is why AF matters even when you feel completely fine — silent AF carries the same stroke risk as symptomatic AF. Your heart doesn't have to feel different for AF to affect your health.
Section 3
Why AF Matters: The Stroke Risk
The biggest concern with AF is stroke. People with AF have a stroke risk that is approximately 4 to 5 times higher than people without it. Understanding why this happens is the key to understanding why treatment matters so much.
When your heart's upper chambers quiver instead of pumping properly, blood can pool and form clots — particularly in a small pouch called the left atrial appendage. If a clot breaks loose and travels through the bloodstream to your brain, it causes a stroke. Importantly, strokes caused by AF tend to be more severe and more disabling than other types of stroke.
Without treatment, someone with AF and other risk factors might face a stroke risk of 4% or more each year. The good news is that with modern blood-thinning medications, this risk can be dramatically reduced — giving you and your family genuine peace of mind.
4–5x
Higher Stroke Risk
Compared to people without AF
~65%
Risk Reduction
With anticoagulation compared to no treatment
60–80%
With Modern Treatment
Reduction in stroke risk using contemporary blood thinners
Understanding this pathway makes it clear why anticoagulation — preventing those clots from forming in the first place — is the cornerstone of AF management. Treatment can interrupt this chain of events at the very first step.
Section 4
How Do We Reduce the Risk?
The Role of Anticoagulation ("Blood Thinners")
The cornerstone of stroke prevention in AF is anticoagulation — medications often called "blood thinners." These medicines don't literally thin your blood, but they do make it significantly less likely to form dangerous clots. For most people with AF and risk factors, taking an anticoagulant daily is the single most important step they can take.
DOACs: The Modern Standard
For most people today, doctors prescribe medications called direct oral anticoagulants, or DOACs. In Australia, these are available on the PBS and include apixaban (Eliquis), rivaroxaban (Xarelto), dabigatran (Pradaxa), and edoxaban (Lixiana). Australian guidelines from the National Heart Foundation and the Cardiac Society of Australia and New Zealand recommend DOACs in preference to warfarin when anticoagulation is indicated.
Your doctor uses a scoring system called the CHA₂DS₂-VA score to assess your individual stroke risk. Anticoagulation is recommended when the score reaches 2 or more. Your doctor will work with you to choose the safest option based on your kidney function, other medications, and personal circumstances.
Why DOACs Are Preferred
Equal or superior stroke prevention vs warfarin
~50% less bleeding in the brain
No regular blood tests required
Fewer food and drug interactions
Available on the PBS in Australia
Balancing Benefits and Risks
Yes, anticoagulants do slightly increase the risk of bleeding. But for most people with AF, the benefit of preventing a potentially devastating stroke far outweighs this risk. Modern blood thinners reduce the risk of brain bleeding by approximately 50% compared with warfarin — making them safer than ever. Your doctor will always weigh the risks and benefits with you individually.
Section 5
Rate vs Rhythm Control
Two ways to manage how AF affects your heart and how you feel day to day
Beyond preventing stroke, we also need to manage how AF affects your heart function and your quality of life. There are two main strategies, and both are legitimate approaches — the right choice depends on you.
⏱ Rate Control
This approach lets the AF continue, but slows your heart rate down to a comfortable level using medications such as beta-blockers or calcium channel blockers. The goal is to keep your heart rate in a safe range so that your heart pumps efficiently and you feel well.
Many people feel dramatically better once their heart rate is controlled — less breathless, less tired, and more able to be active. For older patients or those with few symptoms, rate control is often a highly effective and straightforward option.
💓 Rhythm Control
This approach aims to restore and maintain a normal heart rhythm. Options include anti-arrhythmic medications, a procedure called cardioversion (where we reset your heart rhythm with a controlled electrical impulse), or catheter ablation (where we carefully treat the areas of the heart causing AF).
Recent research suggests that starting rhythm control early — within the first year of diagnosis — may reduce the risk of stroke, heart failure, and other complications. This approach may be especially beneficial for younger, fitter patients with significant symptoms.
"There is no one-size-fits-all approach. Treatment should be tailored to the person, not just the rhythm. Your symptoms, your health, and your goals all matter."
Section 6
What Causes AF?
AF doesn't usually appear out of nowhere. A number of factors increase your risk of developing the condition — and crucially, many of them are things you can actively address. Understanding your own risk profile is the first step towards taking control.
Age
The older we get, the more common AF becomes. The heart's electrical system naturally changes with age.
High Blood Pressure
The single most important modifiable risk factor for AF. Well-controlled blood pressure is one of the best things you can do.
Heart Disease
Including heart failure, valve problems, or prior heart attacks — all of which can alter the heart's structure and electrical activity.
Obesity
Excess weight places physical strain on the heart and promotes inflammation, both of which contribute to AF.
Sleep Apnoea
Disrupted breathing during sleep repeatedly stresses the heart. Treatment of sleep apnoea can meaningfully reduce AF burden.
Diabetes
Affects blood vessels and heart tissue, increasing the likelihood of electrical disturbances in the atria.
Alcohol
Even moderate drinking can trigger AF in some people. Reducing or avoiding alcohol is especially important if you're trying to control your heart rhythm.
Family History
AF can run in families, suggesting a genetic component. If a close relative has AF, let your doctor know.
The Encouraging News
Many AF risk factors are modifiable. What causes AF can often also be part of the solution — meaning the lifestyle changes you make today may reduce your AF burden tomorrow.
Section 7
What Can You Do? Practical Lifestyle Steps
Managing AF isn't just about medications — lifestyle changes can make a profound difference. Much of the most exciting research in this area has come from Australian studies, including the LEGACY, CARDIO-FIT, ARREST-AF, and REVERSE-AF trials. Here's what the evidence shows.
Lose Weight if Needed
The LEGACY study found that patients who achieved at least 10% weight loss had an 86% chance of being free from AF at five years, compared to only 39% in those who lost less than 3%. For some people, weight loss is as effective as medical treatments — a remarkable finding from Australian researchers.
Stay Active
The CARDIO-FIT study showed that for every 1 MET increase in cardiorespiratory fitness, there was a 20% reduction in AF recurrence. Aim for at least 150 minutes of moderate activity — such as brisk walking — per week. The combination of improved fitness and weight loss provides the best outcomes.
Control Your Blood Pressure
Blood pressure is the single most important modifiable AF risk factor. Take your medications consistently, monitor at home if possible, and work with your GP to keep it in a healthy range. Even small improvements in blood pressure control can reduce AF burden.
Limit or Avoid Alcohol
Even small amounts of alcohol can trigger AF episodes in susceptible individuals. If you're trying to control your heart rhythm, minimising or avoiding alcohol is especially important. Discuss your alcohol intake honestly with your doctor.
Treat Sleep Apnoea
If you snore loudly, wake unrefreshed, or feel tired despite adequate sleep, ask your doctor about sleep apnoea testing. Treatment with a CPAP machine can meaningfully reduce AF episodes and improve your overall cardiovascular health.
10%
Weight Loss Target
Can significantly reduce AF burden
86%
Free from AF at 5 Years
In the highest weight-loss group (LEGACY study)
20%
Lower AF Recurrence
For every 1 MET gain in fitness (CARDIO-FIT study)
Section 8
Common Myths About AF
Misinformation about AF is widespread — and it can lead people to delay treatment or stop taking important medications. Let's set the record straight with the facts.
❌ Myth: "AF is harmless if I feel fine"
The Fact: Even without symptoms, AF increases your stroke risk by 4 to 5 times. Treatment decisions are based on your stroke risk profile — not on how you feel. Silent AF is just as dangerous as symptomatic AF, and requires the same attention.
❌ Myth: "Blood thinners are too dangerous"
The Fact: Whilst anticoagulants do slightly increase the risk of bleeding, for most people with AF the stroke prevention benefit is far greater than the bleeding risk. Modern DOACs are safer than ever — they reduce the risk of bleeding in the brain by approximately 50% compared with warfarin. For most patients, not taking anticoagulation is the riskier choice.
❌ Myth: "I only need treatment when I have symptoms"
The Fact: AF comes and goes for many people, but stroke risk is present whether you're in AF at that moment or not. Anticoagulation is usually recommended continuously, not just during symptomatic episodes. Stopping and starting is both dangerous and less effective.
Summary
Practical Take-Home Message
If you've been diagnosed with AF, here is what the evidence says — and what it means for you in practical terms.
AF Is Common and Manageable
Hundreds of thousands of Australians live full, active lives with this condition. A diagnosis of AF is not a sentence — it's an opportunity to take control of your heart health.
Stroke Prevention Is the Top Priority
For most people, this means taking an anticoagulant medication daily. This single step can reduce your stroke risk by 60% to 80% — one of the most powerful interventions in all of medicine.
Lifestyle Changes Really Matter
Australian research has shown that weight loss, exercise, blood pressure control, and limiting alcohol can reduce AF episodes — sometimes as dramatically as medical treatments. The combination of weight loss and improved fitness gives the best results.
You Have Options
AF management is not one-size-fits-all. Work with your doctor to find the treatment approach that fits your life, your symptoms, and your goals.
Stay Engaged
Ask questions. Understand why you're taking each medication. Let your doctor know if treatments aren't working or if you're having side effects. You are an active partner in your care — not just a passenger.
"AF changes the rhythm of the heart, but with the right care, it does not have to change the course of your life."
AF is a condition you'll manage long term. But with the right approach — the right medications, the right lifestyle changes, and the right conversations with your healthcare team — you can significantly reduce your risks and maintain the quality of life you deserve.
References
References
Ball J, Thompson DR, Ski CF, et al. Estimating the Current and Future Prevalence of Atrial Fibrillation in the Australian Adult Population. The Medical Journal of Australia. 2015;202(1):32–5. doi:10.5694/mja14.00238
Ko D, Chung MK, Evans PT, Benjamin EJ, Helm RH. Atrial Fibrillation: A Review. JAMA. 2025;333(4):329–342. doi:10.1001/jama.2024.22451
Michaud GF, Stevenson WG. Atrial Fibrillation. The New England Journal of Medicine. 2021;384(4):353–361. doi:10.1056/NEJMcp2023658
Diener HC, Hankey GJ. Primary and Secondary Prevention of Ischemic Stroke and Cerebral Hemorrhage: JACC Focus Seminar. Journal of the American College of Cardiology. 2020;75(15):1804–1818. doi:10.1016/j.jacc.2019.12.072
Brieger D, Amerena J, Attia JR, et al. National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Australian Clinical Guidelines for the Diagnosis and Management of Atrial Fibrillation 2018. The Medical Journal of Australia. 2018;209(8):356–362. doi:10.5694/mja18.00646
Tucker WJ, Fegers-Wustrow I, Halle M, et al. Exercise for Primary and Secondary Prevention of Cardiovascular Disease: JACC Focus Seminar 1/4. Journal of the American College of Cardiology. 2022;80(11):1091–1106. doi:10.1016/j.jacc.2022.07.004
Chung MK, Eckhardt LL, Chen LY, et al. Lifestyle and Risk Factor Modification for Reduction of Atrial Fibrillation: A Scientific Statement From the American Heart Association. Circulation. 2020;141(16):e750–e772. doi:10.1161/CIR.0000000000000748
This article is intended for general information purposes only. It does not constitute medical advice and should not replace consultation with a qualified healthcare professional. Always speak with your doctor about your individual circumstances before making changes to your treatment.