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Researchers warn of ‘treatment gap’ for patients with intermittent atrial fibrillation

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There is an anticoagulant “treatment gap” in patients with the form of atrial fibrillation (AF) that comes and goes, according to UK researchers.

Atrial fibrillation ­– causing an irregular or abnormally fast heartbeat – is the most common sustained cardiac arrhythmia and is associated with a five-fold increase in risk of stroke.

“Paroxysmal AF patients should be given the same priority for stroke prevention”

Nicola Adderley

UK guidelines recommend anticoagulant treatment, such as warfarin, for patients with all types of atrial fibrillation – paroxysmal, persistent or permanent – in order to reduce the risk of stroke.

A new study, carried out by the University of Birmingham and published in the journal Heart, has found patients with paroxysmal AF are significantly less likely to receive anticoagulants for stroke prevention than other AF patients.

They investigated trends in AF treatment between 2000 and 2015 by looking at primary care data on 14 million patients from 648 practices across the UK.

In 2000, they found eligible patients with paroxysmal AF were half as likely to be treated with anticoagulants as patients with other AF.

This trend has improved over time, according to their anlaysis. But they found eligible patients with paroxysmal AF were still around 20% less likely to be prescribed anticoagulant medication in 2015.

Corresponding author Dr Nicola Adderley said: “We found that patients with paroxysmal AF were consistently less likely to be prescribed anticoagulants than those with persistent or permanent AF.

“Although the proportion of AF patients prescribed anticoagulants increased considerably, in 2015 fewer paroxysmal AF patients were prescribed anticoagulants – a treatment gap of 13%,” she said.

University of Birmingham

‘Treatment gap’ for patients with intermittent atrial fibrillation

Dr Nicola Adderley

“While the anticoagulant treatment gap has narrowed over the years, from 15% in 2000 to 13% in 2015, over the same period a diagnosis of paroxysmal AF became three times more common,” she said.

“This means that the number of paroxysmal AF patients missing out on anticoagulants is greater now than 16 years ago,” said Ms Adderley.

She added: “Underuse of anticoagulants in patients with paroxysmal AF is likely to result in preventable strokes among this group, leading to greater levels of avoidable death and disability.”

“We need to remind ourselves that all patients with AF are at increased risk of stroke,” she said. “Paroxysmal AF patients should be given the same priority for stroke prevention as other AF patients.”

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