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Warfarin and echo underused in AF

NICE guidelines on atrial fibrillation could be leading to underuse of warfarin in primary care, GPs are being warned.

A new audit found only half of high-risk patients were on warfarin, and also uncovered serious underuse of echocardiography.

Dr Bryan Loo, senior registrar in cardiology at the Torbay Hospital in Devon, looked at 3,347 patients with atrial fibrillation from 27 Devon practices. 'We found 44% of patients had echo – in patients managed in primary care 15% had an echo, compared with 72% in hospital,' he said.

Only 49% of high-risk patients were taking warfarin or had an explicit contraindication, with warfarin use not matching levels of risk.

Professor David Fitzmaurice, professor of primary care at the University of Birmingham, said: 'For everybody you're thinking of treating with thromboprophylaxis, you should consider warfarin first-line.'

He said the NICE guidelines saying warfarin and aspirin were both options 'haven't done us any favours'. 'We should be more paternal about it,' he said. 'Warfarin does save lives – it's the most powerful weapon we have in medicine.'

Dr Edward Rowland, consultant in cardiology at St George's Hospital, London, added: 'My belief is everybody should have an echo who has atrial fibrillation. That's a standard we have to strive for – it isn't achievable at the moment but we have to strive for it.'

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