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.
Atrial fibrillation management: We can do better
Detect, protect, perfect: AHSNs going further, faster to reduce AF-related stroke
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.
Monitoring patients with AF on DOACs
Many patients with atrial fibrillation are treated with direct oral anticoagulants (DOACs) to reduce the risk of stroke. To maintain patient safety, clinicians must be educated on how to manage DOACs, from safe prescribing to managing complications. A recent audit shows the potential for inadequate monitoring when compared to local clinical protocols.
Back to Basics: NOAC patient information card
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.
Case study: Optimising detection and stroke prevention in patients with atrial fibrillation
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.
Back to Basics: What goes wrong in atrial fibrillation?
Atrial fibrillation (AF) is the commonest sustained cardiac dysrhythmia, and an important risk factor for stroke and systemic thromboembolic events. This wall chart outlines AF risk factors, and compares AF with normal heart rhythm.
AF and stroke prevention: Case finding in primary care
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.
Stroke prevention in atrial fibrillation
The prevalence of atrial fibrillation (AF), together with the condition’s associated stroke and systemic thromboembolic risk, is increasing significantly. Fortunately, there are clear, evidence-based clinical guidelines and risk stratification tools, to ensure that patients can make informed choices about optimising their treatment and care.
Case study: Atrial fibrillation
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.
Back to Basics: How atrial fibrillation develops
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.
Using the novel oral anticoagulants in primary care
Stroke related to atrial fibrillation can be prevented effectively through the use of anticoagulants. This article reviews recent guidelines, clinical trials and real-world evidence with non-vitamin K antagonist oral anticoagulants (NOACs) in patients with AF and provides practical guidance on the use of these newer agents in primary care.
Improving anticoagulation in patients with atrial fibrillation
A new case study shows the significant reduction in atrial fibrillation-related stroke incidence achieved using the GRASP-AF audit tool. The case study, highlights improvements in key measures including a 4% reduction in the number of patients treated inappropriately, a 5% increase in the use of oral anticoagulation therapy and a 10% reduction in AF-related strokes.