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Atrial fibrillation

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About atrial fibrillation

Atrial fibrillation (AF) has been diagnosed in about 1.3 million patients and many more remain undiagnosed.

AF increases the risk of stroke up to five times and is significantly associated with death and hospitalisation, as well as being strongly linked to heart failure and vascular dementia.

Early detection of atrial fibrillation is critically important, with an increased frequency of pulse checks in those >65 years shown to simply identify patients at risk.

There have been important developments in the use of anticoagulant therapy.

Evidence based tools for risk assessment – particularly CHA2DS2-VASc Score is recommended to maximise the risk of bleeding in non-valvular AF.

New therapeutics – The direct oral anticoagulants (DOACs) – have offered more convenient and easier to use therapy versus the previous standard of Warfarin. Direct factor Xa inhibitors (Adixaban, Rivaroxoban and Endoxaban) and the direct thrombin inhibitor (Dabigatran) have become widely used in primary care.

Atrial fibrillation management: We can do better

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.

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. 

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.

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