Background
Atrial fibrillation affects 1-2% of the general population and 10% of those over 75 and is responsible for around a quarter of all strokes. These strokes are largely preventable by the use of anticoagulation therapy, though many eligible patients are not treated appropriately. Recent clinical trials have added to the evidence base on stroke prevention and international clinical guidelines have been updated.
Design
Consensus practical recommendations from primary care physicians with an interest in vascular disease and vascular specialists.
Methods
Focussed all-day meeting, with presentation of summary evidence under each section of this guidance and review of European guidelines on stroke prevention in atrial fibrillation, generated a draft document, which then underwent 3 cycles of revision and debate before all panel members agreed with the consensus statements.
Results
Six areas were identified that included how to identify patients with atrial fibrillation, how to determine their stroke risk and whether to recommend modification of this risk, and what management options are available, with practical recommendations on maximising benefit and
minimising risk if anticoagulation is recommended and the reasons why antiplatelet therapy is no longer recommended. The summary evidence is presented for each area and simple summary recommendations are highlighted, with areas of remaining uncertainty listed.
Conclusions
Atrial fibrillation related stroke is a very major public health priority for most health systems. This practical guidance can assist generalist community physicians to translate the large evidence base for this major cause of preventable stroke and implement this at a local level. The guidance is slightly more conservative guidance on who to treat.
Stroke prevention in atrial fibrillation
Four European Primary Care experts, prof. Richard Hobbs, prof. David Fitzmaurice, Clare Taylor MD and Frans Rutten MD, summarise a fascinating discussion at the stroke prevention in atrial fibrillation expert meeting.
See also the risk scoring tools mentioned in the SPAF Consensus document:
CHADS2 and CHA2DS2-VASc risk scoring tools
HAS-BLED bleeding risk assessment score
You may also find the EHRA Practical Guide on the use of new oral anticoagulants in patients with non-valvular atrial fibrillation useful. Follow this link to download the guide.
An updated version of the EHRA Practical Guide was published in March 2018. Follow this link
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An abbreviated version is published at ejpc.sagepub.com (DOI: 10.1177/2047487315571890). Published online before print February 20, 2015
The final, definitive version of this paper has been published in European Journal of Preventive Cardiology, vol. 23 (5): 460-473, March 2016 by SAGE Publications Ltd, All rights reserved. © The European Society of Cardiology.