One in four low-risk atrial fibrillation patients 'inappropriately anticoagulated'
More than a quarter of patients with atrial fibrillation who are at low risk of stroke are being ‘inappropriately’ prescribed an oral anticoagulant, a recent audit of UK general practices has claimed.
Researchers ran the computerised GRASP-AF (Guidance on Risk Assessment and Stroke Prevention in Atrial Fibrillation) audit tool on electronic records of 11 general practices.
Of the 7.5% of patients with atrial fibrillation who were considered at low risk of stroke, according to the CHA2DS2-VASc score now endorsed by NICE guidelines for atrial fibrillation, 28%were on oral anticoagulants.
Just half of patients at moderate-high risk of stroke were on the recommended treatment of an oral anticoagulant, while about 40% were on an antiplatelet - which is no longer recommended for stroke prevention.
The researchers concluded: ‘Oral anticoagulant therapy in atrial fibrillation remains suboptimal in the UK general practice settings, with suboptimal treatment of high-risk patients and inappropriate oral anticoagulant use in low-risk patients.
‘Aspirin monotherapy use remained excessive in high-risk patients, despite exposing such patients to an increased risk of stroke.’
The findings were presented at a poster session at the annual European Society of Cardiology congress in Barcelona.
European Society of Cardiology Congress 2014; Abstract P2630
Readers' comments (6)
Anonymous | Salaried GP05 Sep 2014 5:09pm
With lots of new anticoagulants available to secondary care, referral of all patients with AF to specialists to discuss treatment would be the ideal option.
Why should patients be denied the opportunity to see a specialist?
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Anonymous | Sessional/Locum GP05 Sep 2014 6:41pm
Anonymous | Salaried GP | 05 September 2014 4:09pm
Really?
Why not just refer all the cough and colds too?
AF is bread and butter GP. We're in a far better position to judge the patient than a specialist when it comes to AF risk/bleed risk.
There are 3 new agents, all of which does the exact same thing and all of which have similar risks/benefits. All of which are responsible for 80% of our drug reps for some reason.
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Vinci Ho | GP Partner05 Sep 2014 6:51pm
I think there is some readjustment behaviour as CHA2DS2-VASc is being endorsed in QOF.
Phasing out aspirin seems to be the first priority
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Anonymous | Salaried GP05 Sep 2014 9:07pm
Anonymous | Sessional/Locum GP | 05 September 2014 5:41pm
If that was the case, and if you had all day to discuss all pros and cons, surely you should be able to prescribe those for patients...So, why is this not happening?
They are specialists for a reason- good at something specific, and look at the audit findings- it is not shameful to accept your limitations as a GP, better than pretending that you know everything..
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Anonymous | Sessional/Locum GP07 Sep 2014 0:47am
anon 5th sept 08:07
referral to sencondary care purely for anticoag seems like a waste of a specialists time. Something so common can hardly be a specialists domain esp when all you have to do is add their risk factors in to a calculation and click enter. perhaps these people are on the 'wrong' treatment because they chose that. I know patients I have tried to persuade to stop aspirin and start warfarin refuse as they see one as more dangerous even after explaining aspirin is pointless and risky.
if GPs cant work out chads2vasc then they just havent bothered or perhaps they don't believe in it.
Of course if you decide someone should be on one of the new 3 anticoagulants then they will need to be referred or if they need symptom control but not so a cardiologist can work out their chads2vasc score surely
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Anonymous | GP Partner08 Sep 2014 6:35pm
GPs no longer have the time to do this. A cardiologist will be able to do this in their sleep,while we will be slow and cumbersome in considering all the factors.
Yes, perhaps the GP could do it cheaper but only if we had more capacity so we could spend more time with these complicated issues.
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