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150,000 patients with resolved AF 'should still be on anticoagulation'

Nearly 150,000 patients who have had their AF resolved remain at a high risk of stroke and should still be treated with anticoagulants, researchers have said.

A study in the BMJ has found that patients with AF marked as ‘resolved’ had a 45% increased risk of suffering a stroke when compared with patients without any history of AF.

The researchers have called for action to be taken to change QOF and include patients with resolved AF. 

The research looked at records from a UK primary care database for just over 11,000 patients with a ‘resolved AF’ code and compared them to around 22,000 controls who did not have AF.

The analysis excluded patients with resolved AF who went on to have a record of ‘recurrent’ AF at a later stage.

Absolute incidence rates for stroke or TIA were 12.1 per 1,000 person years for those with resolved AF, and 7.4 per 1,000 person years for patients without AF.

The researchers suggested in the paper that the findings of the study have important implications for national guidelines.

They said: ‘Patients with a diagnosis of resolved atrial fibrillation have increased as a proportion of patients with atrial fibrillation. These patients would benefit from continued anticoagulant prophylaxis, but treatment rates in this group are extremely low. It is recommended that national and international guidelines are updated to advocate continued use of anticoagulant treatment in patients with resolved atrial fibrillation.’

Study author Professor Tom Marshall, professor of public health and primary care at the University of Birmingham, told Pulse that according to the research 'the most recent estimate is that 10.5% of AF patients have an “AF resolved” code'.

He said: 'Public Health England estimate there are about 1.4 million patients with AF so this means about 147,000 have "AF resolved” codes.'

He added: ‘The problem is that ‘AF resolved’ means that patients are no longer followed up and within three months 90% have stopped treatment.

‘The simplest solution would be for GPs to identify patients with "AF resolved" codes, offer them anticoagulants again and put them back on the AF register for follow up and ongoing anticoagulation.

‘But this also needs action to change QOF because QOF does not include patients with "AF resolved". This is not anybody’s fault. Until our paper was published we didn’t realise that patients with an "AF resolved" code were still at the same risk of stroke.’

However, this comes as QOF is under review by NHS England and GP leaders with the framework looking set to be slashed back to just 3-4% of practice income.

Readers' comments (3)

  • Bornjovial

    even resolved AF has risk of recurrence and increased risk of CVA (exception being lone atrial fibrillation which has no evidence). So yes this consistent with known evidence regarding AF.

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  • David Banner

    Many patients with “resolved” AF simply don’t want warfarin/DOAC, even when the stroke vs bleeding risk is explained to them, especially those with low CHADSVasc scores (usually the younger ones). It should always be an informed choice by the patient, not forced on them by QOF. (which is due to be heavily pruned any way, can’t see them adding new indicators)

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  • As far as I am aware an AF Resolved code means the patient is no longer included on the AF register. This may be why 90% of these patients are no longer receiving prescriptions for anticoagulants 90 days after the AF resolved code.

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