PCCJ Editor-in-Chief Mike Kirby reviews a recent large observational study in the BMJ which concludes that women with atrial fibrillation are at a higher risk of cardiovascular disease and death than men.
Atrial fibrillation (AF) is the commonest sustained cardiac dysrhythmia, but is asymptomatic in about one quarter of patients. Case finding with subsequent assessment of the risk of stroke and bleeding are essential to ensure that the right patients receive appropriate intervention with oral anticoagulation.
Atrial fibrillation (AF) management has been transformed within the last decade by revised clinical guidance and availability of new drugs. Aspirin monotherapy, once accounting for almost half of all antithrombotic prescriptions for AF, is now an obsolete therapy. Anticoagulation is the treatment of choice for AF and direct oral anticoagulants (DOACs) have overtaken warfarin as the drug of first choice for new starters. However, management of one in four people with AF remains suboptimal, and this article reviews the major issues around antithrombotic and other treatments for AF.
This month’s Back to Basics feature is a useful wallchart showing the differences between normal heart rhythm and atrial fibrillation. The chart also includes a list of controllable and non-controllable risk factors for atrial fibrillation.
This month’s Back to Basics feature is a patient information card that is included in the 2018 European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation. The card can be folded into pocket size and is crucial both for the patient and for healthcare providers.
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The document is a valuable summary of the most recent and evidence-based information to assist healthcare professionals in managing patients experiencing bleeding on oral anticoagulation.
This case study describes the diagnosis and management of atrial fibrillation (AF) in a 70-year old obese male who was referred for cardiac assessment after developing shortness of breath, which had worsened progressively over the previous three months. The case study highlights the role of thromboembolic risk reduction which is the cornerstone of AF management and which can only be achieved with proper anticoagulation.
In 2015 West Hampshire CCG (WHCCG) recognised that there was a significant burden of undiagnosed atrial fibrillation (AF), which was resulting in an excess of preventable strokes. This could be improved by the prescription of anticoagulation in those at increased risk. A brief case study describes how the CCG improved outcomes for high-risk patients.
Since 2014 the 15 Academic Health Science Networks (AHSNs) across England have been working on a collaborative atrial fibrillation (AF) programme focused on reducing AF-related stroke. The national programme has three elements: Detect: finding more people with AF to allow early intervention to prevent stroke; Protect: treating more at-risk patients with anticoagulants to reduce the rate of AF-related stroke; and Perfect: improving the quality of anticoagulation to ensure maximal patient outcomes.