AF care ‘inadequate’

By Caroline Price

Cardiology experts are supporting a call for greater attention to diagnosis and management of atrial fibrillation (AF) in primary care to prevent strokes.

In a report produced for parliament, they say that GPs are still prescribing aspirin to patients with AF who are at high risk of stroke. Recent data from one area in England showed that over 40% of patients with a CHADS₂ score of 2 or higher were not receiving warfarin. And, as reported by MedWire News at the time, another study suggested that instead of being more likely to recommend an anticoagulant, GPs are actually more likely to prescribe aspirin the higher a patient's stroke risk is (click here).

The Stroke in Atrial Fibrillation Expert (Safe) report was produced by a panel including cardiologists, GPs and patient groups and the Chair of the AF All-party Parliamentary Group, Glyn Davies MP.

One of the panelists, Dr Alan Begg, a GP in Montrose with a special interest in cardiology, commented: "It is extremely concerning that healthcare professionals often seem to be choosing the 'easy option' rather than better stroke protection. Even experienced doctors falsely believe they are fully protecting people by recommending aspirin."

Many patients with AF are going undiagnosed in the first place, partly because of patchy access to simple investigations such as ECGs, according to the report.

Another GP on the panel, Dr Mark Davis, said: "In Leeds most of our GPs' surgeries have an ECG monitor; however this is not necessarily the case across the rest of the UK. It is so much more convenient and cost effective for patients to be tested within their own GPs' surgeries."

The report, funded by the developers of dabigatran etexilate, Boehringer Ingelheim, also says that, despite NICE backing, novel oral anticoagulants are being underused. It claims many patients who may benefit from the new drugs - such as those unstable on warfarin - are not receiving them, due to "insufficient time to pass through local formulary committees and lack of local guidelines identifying appropriate patients", and because some PCTs have banned their use outright on the basis of cost.

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