Over 260,000 people with atrial fibrillation (AF) could be at risk of stroke as they are receiving either no preventative treatment or are still taking only aspirin, no longer recommended by NICE for the prevention of AF-related stroke. This news comes as a result of a recent review of anonymised GP practice data from across the UK.
These latest figures are announced two years after NICE published guidelines on the management of AF, recommending anticoagulation (blood-thinning treatment) with an oral anticoagulant for AF-related stroke prevention and advising against aspirin on its own to prevent stroke. The data review showed that even in 2016, 140,402 patients (15.7% of patients reviewed) were still not receiving any preventative treatment and 120,905 patients (13.5% of patients reviewed) were still receiving only aspirin for stroke prevention, out of 894,885 patients in total.
“This is a large-scale problem equating to Wembley stadium being filled almost three times over with AF patients receiving no therapy or inappropriate therapy for AF-related stroke prevention,” said Trudie Lobban MBE, CEO and Founder, AF Association, and Founder and Trustee of the Arrhythmia Alliance. “AF-related strokes are nearly twice as fatal as non-AF-related strokes. For patients who survive, the effects are devastating and life-changing for both patients and their loved ones. We have effective therapies that could help prevent these AF-related strokes so we need to ensure all AF patients have the choice to receive them where appropriate.”
Separate data from the end of 2015 looking at stroke services also shows that over one fifth of stroke patients are already in AF on admission: of these, less than half (49%) are taking anticoagulants and 25% are taking only antiplatelet drugs (drugs that prevent blood clotting), such as aspirin.
AF affects more than 1 million people in the UK and AF patients have a five-fold increase in stroke risk. In addition to having a greater risk of death from stroke, AF patients have greater disability, more severe strokes, longer hospital stays and a lower rate of discharge to their own homes compared with people without AF who develop a stroke.
Professor Martin Cowie, Honorary Consultant Cardiologist at the Royal Brompton and Harefield NHS Foundation Trust says: “It is extremely worrying to see so many patients with AF at risk of stroke because they aren’t taking anticoagulation therapy or in many cases aspirin is still being prescribed. Aspirin has many valid uses but it has been shown to be inappropriate for the prevention of AF-related stroke. People with AF not receiving any anticoagulation or remaining on aspirin solely for stroke prevention require urgent review of their treatment and, if appropriate, initiation of anticoagulation therapy to help avoid a preventable and devastating stroke. The medical community needs to wake up to the current situation and make urgent changes to improve the level of care people can expect in the UK.”
To encourage implementation of the NICE CG180 guideline, the AF180 Degrees Campaign (AF180) has been developed by a group of expert healthcare professionals and patient advocates to support change in order to prevent AF-related strokes, in line with NICE Clinical Guideline 180. It is aimed at people with an interest in the prevention of AF-related stroke, including patients. Recommended roles and responsibilities for healthcare professionals, patients, their families and carers, the general public and commissioners to improve AF-related diagnosis and management have been developed along with the top 5 questions patients with AF should ask their doctor when discussing treatment to prevent an AF-related stroke. AF180was initiated by the AF Association, AntiCoagulation Europe, the Arrhythmia Alliance, and an Alliance between Bristol-Myers Squibb Pharmaceuticals Ltd and Pfizer Ltd (the BMS-Pfizer Alliance) and is funded by the BMS-Pfizer Alliance.
To find out more about the campaign and to download the roles and responsibilities and patient questions document, please visit the campaign website at www.AF180.co.uk.