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Patients with resolved AF still need anticoagulation

Patients with resolved AF still need anticoagulation

Publication date: Wednesday, 30 May 2018
Contributor(s): Jeremy Bray

Patients with atrial fibrillation (AF) still need treatment even after their heart rhythm seems to have returned to normal, according to a recent paper in the BMJ. They remain at a 60% greater risk of stroke or transient ischaemic attack (TIA) than patients without AF.

Sometimes atrial fibrillation seems to resolve and the heart goes back to its normal rhythm. Until now it has been unclear as to whether anticoagulant prophylaxis can be safely stopped when the condition is resolved. Now a study by researchers at the University of Birmingham has found that people whose heart rhythm returns to normal continue to be at high risk of stroke and should continue to be treated.

Researchers looked at patient records from 640 general practices throughout the UK and compared the frequency of strokes in three groups of people: those with ongoing atrial fibrillation; those whose records said that atrial fibrillation had resolved; and those who never had atrial fibrillation.

Lead author Dr Nicola Adderley said: “What we found was that strokes were least common in people who never had atrial fibrillation, and much more common in people whose records said their atrial fibrillation had been resolved. Significantly, in recent years we found that strokes were nearly as common in people whose atrial fibrillation had resolved as in those with ongoing atrial fibrillation.

The research also demonstrated that although people with resolved atrial fibrillation continue to be at high risk of stroke, they are not getting their prevention drugs. Worryingly, this issue seems to be becoming more common.

The researchers said that in 2016 one in 10 people with atrial fibrillation – around 160,000 people in the UK – were classed to have had their condition resolved. They concluded that these patients are still at high risk of stroke and should still be treated. Dr Tom Marshall added, “We cannot ever safely consider atrial fibrillation to have resolved.”

 

Key results

 

- Participants: 11,159 with resolved AF; 15,059 with AF; 22,266 with no AF

- Adjusted incidence rate ratios: for stroke/TIA for patients with resolved AF:

  • 0.76 (95% CI 0.67 to 0.85, P<0.001) vs controls with AF
  • 1.63 (1.46 to 1.83, P<0.001) vs controls without AF

- Adjusted incidence rate ratios: for mortality in patients with resolved AF

  • 0.60 (0.56 to 0.65, P<0.001) vs controls with AF
  • 1.13 (1.06 to 1.21, P<0.001) vs controls without AF

 

ACTION

This study shows that people with resolved atrial fibrillation continue to be at high risk of stroke. More than 10% of patients with AF are coded as ‘AF resolved’. GP surgeries should ensure that people with atrial fibrillation are reviewed regularly and are not taken off the register prematurely. The study authors recommend that national and international guidelines are updated to advocate continued use of anticoagulant treatment in patients with resolved AF.

 

Adderley N et al. Risk of stroke and transient ischaemic attack in patients with a diagnosis of 'resolved' atrial fibrillation. BMJ 2018;361:k1717.

Topics covered:
Category: Evidence in Practice
Edition: Volume 3 Number 7 PCCJ Online 2018
Contributor(s): Jeremy Bray

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