RCPE UK Consensus Conference on ‘Approaching the comprehensive management

Stott, David J.; Dewar, Richard; Garratt, Clifford J.; Griffith, K.; Harding, N. J.; Metcalfe, James; Lane, Deirdre A.; Petty, Duncan; Smith, Patty; Somerville, Mari; Trueland, Jennifer

doi:10.4997/jrcpe.2012.s01

Cited by 28 publications

(19 citation statements)

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“…Importantly, 64 % of AF-related strokes can be prevented if AF is detected early and appropriate treatment initiated [3]. Although opportunistic AF screening is recommended by guidelines [4,5], it is not routinely performed; hence, AF often remains undetected until stroke occurs, as it is frequently asymptomatic [6]. Therefore, options for community-based screening for AF should be explored.…”

Section: Introductionmentioning

confidence: 99%

Atrial fibrillation screening in pharmacies using an iPhone ECG: a qualitative review of implementation

et al. 2015

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Atrial fibrillation screening in pharmacies is well accepted by pharmacists and customers. Many pharmacists combined atrial fibrillation screening with other health screens reporting improved time-efficiency and greater customer satisfaction. Widespread implementation of atrial fibrillation screening requires longterm funding, which could be provided for a combined cardiovascular screening service. Further research could focus on feasibility and cost-effectiveness of combined cardiovascular screening in pharmacies.

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Section: Introductionmentioning

confidence: 99%

Atrial fibrillation screening in pharmacies using an iPhone ECG: a qualitative review of implementation

et al. 2015

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“…In 2011 new oral anticoagulant agents were licensed in the UK and recommended by the National Institute for Health and Care Excellence (NICE) where warfarin could not be used. In addition the failure of aspirin to reduce stroke in AF and the risk of bleeding at older ages has been emphasised to ensure appropriate use 15 16…”

Section: Introductionmentioning

confidence: 99%

Ethnicity and stroke risk in patients with atrial fibrillation

Mathur

Pollara

Hull

et al. 2013

Heart

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Despite a reduced prevalence of AF among South Asian patients, their risk of stroke is higher than for white patients or black African/Caribbean patients in association with diabetes, cardiovascular disease, and hypertension. Under-prescription of anticoagulation persists in all ethnic groups, a deficit most pronounced in the elderly. Use of the CHA2DS2VASc score would enhance optimal management in primary care.

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“…34 According to the present survey results and their threshold, this would mean that around 91.6% of people with AF should be considered for this treatment. Strokes related to AF are associated with higher case fatality and more profound disability in survivors than non-AF related strokes, 35 but could be minimised by this approach.…”

Section: Competing Interestsmentioning

confidence: 99%

Risk of stroke and oral anticoagulant use in atrial fibrillation: a cross-sectional survey

Holt¹,

Hunter²,

Gunnarsson³

et al. 2012

Br J Gen Pract

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BackgroundOral anticoagulants substantially reduce the risk of stroke in atrial fibrillation but are underutilised in current practice. AimTo measure the distribution of stroke risk in patients with atrial fibrillation (using the CHADS 2 and CHA 2 DS 2 -VASc scores) and changes in oral anticoagulant use during 2007-2010. Design and settingLongitudinal series of cross-sectional survey in 583 UK practices linked to the QResearch ® database providing 99 351 anonymised electronic records from people with atrial fibrillation. MethodThe proportion of patients in each CHADS 2 and CHA 2 DS 2 -VASc risk band in 2010 was calculated; for each of the years 2007-2010, the proportions with risk scores ≥2 that were using anticoagulants or antiplatelet agents were estimated. The proportions identified at high risk were re-estimated using alternative definitions of hypertension based on coded data. Finally, the prevalence of comorbid conditions in treated and untreated high-risk (CHADS 2 ≥2) groups was derived. ResultsThe proportion at high risk of stroke in 2010 was 56.9% according to the CHADS 2 ≥2 threshold, and 84.5% according to CHA 2 DS 2 -VASc ≥2 threshold. The proportions of these groups receiving anticoagulants were 53.0% and 50.7% respectively and increased during 2007-2010. The means of identifying the population of individuals with hypertension significantly influenced the estimated proportion at high risk. Comorbid conditions associated with avoidance of anticoagulants included history of falls, use of nonsteroidal anti-inflammatory drugs, and dementia. ConclusionOral anticoagulant use in atrial fibrillation has increased in UK practice since 2007, but remains suboptimal. Improved coding of hypertension is required to support systematic identification of individuals at high risk of stroke and could be assisted by practice-based software.

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RCPE UK Consensus Conference on ‘Approaching the comprehensive management

Cited by 28 publications

References 0 publications

Atrial fibrillation screening in pharmacies using an iPhone ECG: a qualitative review of implementation

Atrial fibrillation screening in pharmacies using an iPhone ECG: a qualitative review of implementation

Ethnicity and stroke risk in patients with atrial fibrillation

Risk of stroke and oral anticoagulant use in atrial fibrillation: a cross-sectional survey

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