Experts call for better management of atrial fibrillation


A new report launched on 3 July written by UK experts shows that atrial fibrillation, a condition that affects up to 1 million people in the UK, is not being optimally managed. The report warns that UK GPs are often prescribing aspirin for stroke prevention in patients with atrial fibrillation, including those eligible for anticoagulation, despite clinical evidence demonstrating that stroke protection provided by anticoagulant therapies is far superior.

The report titled “Stroke in atrial fibrillation expert report” (sAFe report) aims to improve understanding of the issues and challenges involved in the current management of stroke prevention in atrial fibrillation, and will lead to improvements in patient treatment, outcomes, and experience.

The report was developed and authored by an independent panel of UK experts, comprising of Martin Cowie, professor of Cardiology, Imperial College London; John Camm, Division of Clinical Sciences at St George’s University of London, London and consultant cardiologist, St George’s Healthcare Trust, London; Alan Begg, GP with special interest in Cardiology, Montrose, UK; Paul Kalra, consultant cardiologist, Portsmouth NHS Trust, Portsmouth, UK; Ian Menown, consultant cardiologist, Craigavon Cardiac Centre, Craigavon and honorary senior lecturer, Queen’s University, Belfast, UK; Mark Davis, principal in General Practice in Leeds, UK; the Stroke Association, Atrial Fibrillation Association,
Anticoagulation Europe and Glyn Davies, MP and chair of the atrial fibrillation all party parliamentary group (AFAPPG).

“It has long been recognised by UK experts from trial evidence that aspirin is less effective at preventing stroke in patients with atrial fibrillation. It is extremely concerning that HCPs often seem to be choosing the ‘easy option’ rather than better stroke protection. Even experienced doctors falsely believe they are fully protecting people by recommending aspirin, but in atrial fibrillation it does not offer the best protection against strokes. It is essential that all at risk patients are protected against life-threatening strokes through the appropriate prescribing of anticoagulation therapy,” said Begg.

The report addresses this and other current issues in atrial fibrillation management whilst warning that UK prevalence of this life threatening condition is expected to double within the next 50 years.

The Taskforce also calls for a more defined patient pathway and increased screening at every appropriate opportunity, as a way to ensure early detection and better protection. The report outlines that despite readily available checks, around half of atrial fibrillation patients remain undetected, placing thousands of people at a five-fold increase the risk of stroke, compared to risk in non-atrial fibrillation patients. A recent conference organised by the Royal College of Physicians of Edinburgh recommended opportunistic pulse checking of people over 65 by GPs, however the sAFe report reveals that this is not occurring in real-life clinical practice.

Camm commented: “Many healthcare professionals have been taught in the past that atrial fibrillation is a minor problem and not a dangerous arrhythmia. It is concerning that GPs and other doctors are not actively screening at risk people for atrial fibrillation. There are a great many undiagnosed atrial fibrillation patients in the UK and it is essential that an opportunistic atrial fibrillation screening programme is implemented to reduce the occurrence of life-threatening and debilitating strokes. With prevalence set to double within the next 50 years, we need to get to grips with this escalating problem.”

In order to ensure that atrial fibrillation patients are optimally protected against stroke, the sAFe report also calls for better atrial fibrillation disease education of both the public and healthcare professionals.

In recent months, the advent of new oral anticoagulants has marked a step change in the UK management of atrial fibrillation. The National Institute for Health and Clinical Excellence (NICE) has recently approved two new oral anticoagulants which are cost effective in stroke prevention for people with atrial fibrillation.

The sAFe report states that it is imperative that all at risk patients are protected against life-threatening strokes through the appropriate prescription of anticoagulants.

Davies commented: “The outlook for patients with atrial fibrillation has improved over the last decade, especially with diagnosis and the introduction of new oral anticoagulants. However, there still remains regional variation in managing these patients. We have reached a critical juncture, and we need to challenge the way we diagnose, treat and manage this potentially life threatening condition to further improve the outcome for patients. The atrial fibrillation community need to work together to provide a better outlook for patients in the UK.”

This report was commissioned and funded by Boehringer Ingelheim (UK).