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Under-65s with AF ‘should have regular review’ for hypertension, heart failure and diabetes

Under-65s with AF ‘should have regular review’ for hypertension, heart failure and diabetes

Under-65s with a diagnosis of atrial fibrillation (AF) are more at risk of developing hypertension, heart failure and diabetes than the general population and should be reviewed regularly, say UK researchers.

It provides more evidence for GPs on how best to manage this growing group of patients who do not yet meet the threshold for anticoagulant treatment, the researchers said.

Using records from a general practice research database, the team looked at 18,178 patients who were diagnosed with AF under the age of 65 years, the paper in the British Journal of General Practice found.

Of the roughly half who were not eligible for anticoagulation, the researchers followed them until they turned 65, and found 23% developed an additional cardiovascular risk factor.

Hypertension and heart failure were most common risk factors to develop in this group, the analysis of records from 2004 to 2018 showed.

More opportunistic testing and technologies, such as smart watches, are leading to people being diagnosed with AF at a younger age. Yet despite QOF encouraging annual review, this did not seem to be based on any evidence and there was little detail on what to look for, study leader Professor Jonathan Mant, professor of primary care research at the University of Cambridge, said.

Overall, the researchers said the development of risk factors in this group means patients become eligible for anticoagulation treatment at a rate of 6% a year.

It is possible that the association between diagnosis of AF and development of heart failure and hypertension in the first months following diagnosis reflects reverse-causality, the researchers noted.

But the risk of developing heart failure, hypertension or diabetes in this population seems higher than would be expected in the general population, particularly in the case of heart failure, they added.

Speaking with Pulse Professor Mant, who is also running the SAFER study to assess screening for atrial fibrillation to reduce the risk of stroke, says the findings suggest annual review in patients not yet meeting the threshold for treatment is a reasonable approach.

It also guides GPs on what to look for he adds. ‘The guidance in QOF is pretty vague. This suggests it is not just about reviewing AF but checking for other risk factors.’

He said as more people are identified with AF at a younger age, it would be worth continuing to track the epidemiology and risk factors to check they tally with these results.

‘It is not necessarily surprising but when I searched for the evidence, I found no one had really looked into it.’

Another paper published by Professor Mant last week looked at reasons that participants in the SAFER study had chosen not to take part in AF screening.

In a series of interviews with 50 participants common concerns were around the necessity, legitimacy and utility of AF screening despite broadly being in favour of screening in general, he reported in Health Expectations.


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