Half of AF patients denied appropriate stroke treatment

Nearly half of people with atrial fibrillation (AF) are receiving inappropriate treatment for stroke prevention, the results of a cross-sectional survey suggest.

Stroke: many AF patients do not receive correct treatment (photo: SPL)
Stroke: many AF patients do not receive correct treatment (photo: SPL)

Researchers calculated that, of those patients deemed to be at high risk of stroke in 2010 using CHADS2 and CHA2DS2-VASc risk stratification scores, only 53% and 50.7% respectively were receiving anticoagulants.

The majority of the remainder were receiving antiplatelets. Data showed that the proportion of those at risk receiving anticoagulation had increased since 2007, but remained suboptimal.

Dr Tim Holt from the University of Oxford, who presented the research at the RCGP annual conference, described the proportion of patients currently being treated as ‘very small.’

He pointed out that a large number of patients were receiving antiplatelet agents, which guidelines say do not play a major role in stroke prevention in AF.

The study involved 99,351 anonymised electronic records from people with AF, from 583 UK practices linked to the QResearch database.

The researchers estimated that about one in seven high-risk patients would be missed if the hypertension register is used to define hypertensive status.

In addition, a number of co-morbidities were found to be associated with avoidance of anticoagulant use, including a history of falls, use of NSAIDs, dementia and upper GI conditions.

Dr Holt described the situation as a ‘huge missed opportunity’ for stroke prevention. He added: ‘This survey also found that as you get to high risk bands, you imagine that the tendency to prescribe would increase, but it doesn’t. GPs regard fragility as a reason not to prescribe. While this is understandable, it is irrational.

‘Even though the haemorrhage risk increases, the stroke risk increases disproportionately, so the case for anticoagulation is greater in the high-risk population than in the low-risk population.’

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