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GP commissioning being stymied by PCT red tape

Warfarin prescribing for atrial fibrillation has doubled in the last decade but treatment is not being appropriately targeted to patients at the highest risk of stroke, research has shown.

An analysis of trends in the prevalence of atrial fibrillation and treatment between 1994 and 2003 showed that in 2003 only 56.5 per cent of patients with very high stroke risk were on warfarin while 38.2 per cent of patients at low risk were on it.

Study lead Professor Derek Cook, professor of epidemiology at St George's Hospital, London, said warfarin prescribing had increased but treatment did not appear to be getting to high-risk patients.

'There are patients who could benefit who aren't receiving it and there are patients who are receiving it who are at low risk of stroke.

'In the patients who aren't getting it but should, there may be contraindications but we didn't identify them,' he said.

The study, presented earlier this month at the Society for Academic Primary Care annual meeting in Gateshead, analysed Read code data from 131 practices.

Meanwhile, another study presented at the conference and led by Professor Jonathan Mant, senior lecturer in general practice at the University of Birmingham, questioned the 'wisdom' of US guidelines that suggested all patients over 75 with atrial fibrillation were high risk.

Professor Mant said interim results from the BAFTA trial, comparing aspirin versus warfarin in 973 AF patients over 75, showed an annual stroke event rate of 3.2 per cent ­ 'lower than expected'.

Professor David Fitzmaurice, professor of primary care at the University of Birmingham, said some GPs did not prescribe warfarin because they thought that warfarin was a 'dangerous and fiddly' drug, but he added patients had a great deal to gain from the therapy.

By Emma Wilkinson

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