Atrial fibrillation is the most common sustained disturbance of cardiac rhythm. It is a global epidemic and an evolving problem in cardiovascular medicine. Atrial fibrillation is an independent risk factor for embolic stroke, increasing the risk of stroke five-fold. Despite good evidence for the reduction of stroke risk with anticoagulant therapy, there is significant under treatment. Anticoagulant prescribing is frequently discordant with all current guidelines and decision aids with both over and under use of oral anticoagulants. It is important that GPs have up-to-date knowledge about atrial fibrillation in terms of both its diagnosis and management, and that patients have an understanding of anticoagulant medication. This article aims to update knowledge about atrial fibrillation, the use and benefits of anticoagulation with insights on some barriers to anticoagulation in primary care. This article does not cover management of atrial fibrillation with control of cardiac rate or rhythm to maintain cardiac function.
Get full access to this article
View all access options for this article.
References
1.
AdderleyNNirantharakumarKMarshallTet al.(2018) Risk of stroke and transient ischaemic attack in patients with a diagnosis of resolved atrial fibrillation: Retrospective cohort studies. British Medical Journal361: k1717, DOI:10.1136/bmj.k1717.
2.
AnderssonTMBryngelssonIFrobertOet al.(2013) All-cause mortality in 272,186 patients hospitalized with incident atrial fibrillation 1995-2008: A Swedish nationwide long-term case-control study. European Heart Journal34(14): 1061–7. DOI: 10.1093/eurheartj/ehs469.
3.
AwadNCocchioC (2013) Activated prothrombin complex concentrates for the reversal of anticoagulant-associated coagulopathy. Pharmacy and Therapeutics38(11): 696–698, 701.
4.
CammAKirchhofPLipGet al.(2010) Guidelines for the management of atrial fibrillation: The Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). European Heart Journal31: 2369–429. DOI: 10.1093/eurheartj/ehq278.
5.
CateHMarcusDLancéDet al.(2017) Practical guidance on the use of laboratory testing in the management of bleeding in patients receiving direct oral anticoagulants. Vascular Health Risk Management13: 457–467. DOI: 10.2147/VHRM.S126265.
6.
ChughSS (2018) Heart failure and atrial fibrillation: Can we break this nexus?International Journal of Cardiology252: 142–143. DOI: 10.1016/j.ijcard.2017.11.043.
7.
CoyleDCoyleKCameronCet al.(2013) Cost-effectiveness of new oral anticoagulants compared with warfarin in preventing stroke and other cardiovascular events in patients with atrial fibrillation. Value in Health16: 498–506. DOI: 10.1016/j.jval.2013.01.009.
8.
DeshpandeCKogutSWilleyCet al.(2018) Real-world health care costs based on medication adherence and risk of stroke and bleeding in patients treated with novel anticoagulant therapy. Journal of Managed Care and Specialty Pharmacy24(5): 430–439.
9.
JanuaryCWannLSAlpertJSet al.(2014) 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Journal of the American College of Cardiology64(21): e1–76. DOI: 10.1016/j.jacc.2014.03.022.
10.
KarlssonLONilssonSBangMet al.(2018) A clinical decision support tool for improving adherence to guidelines on anticoagulant therapy in patients with atrial fibrillation at risk of stroke: A cluster-randomized trial in a Swedish primary care setting (the CDS-AF study). Public Library of Science Medicine15(3): e1002528, DOI: 10.1371/journal.pmed.1002528.
11.
KirchhofP (2017) Integrated care of patients with atrial fibrillation: The 2016 ESC atrial fibrillation guidelines. Heart103(10): 729–731. DOI: 10.1136/heartjnl-2016-310843.
12.
KirchhofPBenussiSKotechaDet al.(2017) 2016 ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Revista Española de Cardiología (English Edition)70(1): 50, DOI: 10.1016/j.rec.2016.11.033.
13.
KotechaDBreithardtGCammAJet al.(2018) Integrating new approaches to atrial fibrillation management: The 6th AFNET/EHRA consensus conference. Europace20(3): 395–407. DOI: 10.1093/europace/eux318.
14.
Middeldorp M, Pathak R, Meredith M, et al. (2018) Prevention and regressive effect of weight-loss and risk factor modification on atrial fibrillation: The REVERSE-AF study. Europace doi: 10.1093/europace/euy117.
PollackCReillyPEikelboomJet al.(2015) Idarucizumab for dabigatran reversal. New England Journal of Medicine373: 511–520. DOI: 10.1056/NEJMoa1502000.
17.
PughDPughJMeadGEet al.(2011) Attitudes of physicians regarding anticoagulation for atrial fibrillation: A systematic review. Age Ageing40(6): 675–683. DOI: 10.1093/ageing/afr097.
SchnabelRBYinXGonaPet al.(2015) 50 year trends in atrial fibrillation prevalence, incidence, risk factors, and mortality in the Framingham Heart Study: A cohort study. Lancet386(9989): 154–162. DOI: 10.1016/S0140-6736(14)61774-8.
20.
ShawJSiegalD (2018) Pharmacological reversal of the direct oral anticoagulants: A comprehensive review of the literature. Research and Practice in Thrombosis and Haemostasis. . DOI: 10.1002/rth2.12089.
21.
StaerkLWangBPreisSet al.(2018) Lifetime risk of atrial fibrillation according to optimal, borderline, or elevated levels of risk factors: Cohort study based on longitudinal data from the Framingham Heart Study. British Medical Journal361: k1453, DOI: 10.1136/bmj.k1453.
22.
Steffel J, Verhamme P, Potpara T, et al. (2018) The 2018 European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation: Executive summary. Europace 20(8): 1231–1242. DOI: 10.1093/europace/euy054.
WolfPBelangerABelangerEet al.(1996) Secular trends in the prevalence of atrial fibrillation: The Framingham study. American Heart Journal131(4): 790–795. DOI: 10.1016/S0002-8703(96)90288-4.
25.
Ying ZhengMSonjaVSorensenMet al.(2014) Comparison of the cost-effectiveness of new oral anticoagulants for the prevention of stroke and systemic embolism in atrial fibrillation in a UK setting. Clinical Therapeutics36(12): 2015–2028.e2. DOI: 10.1016/j.clinthera.2014.09.015.
26.
ZiffOJCarterPRMcGowanJet al.(2018) The interplay between atrial fibrillation and heart failure on long-term mortality and length of stay: Insights from the United Kingdom Algorithm of Comorbidities, Associations, Length of stay and Mortality (ACALM) registry. International Journal of Cardiology252: 117–121. DOI: 10.1016/j.ijcard.2017.06.033.
