Article

Atrial fibrillation affects 1-2% of the general population and 10% of
those over 75, and is responsible for around a quarter of all strokes. These
strokes are largely preventable by the use of anticoagulation therapy, although
many eligible patients are not treated. Recent large clinical trials have added
to the evidence base on stroke prevention and international clinical guidelines
have been updated.
DESIGN: Consensus practical recommendations from primary care
physicians with an interest in vascular disease and vascular specialists.
METHODS: A focussed all-day meeting, with presentation of summary evidence under
each section of this guidance and review of European guidelines on stroke
prevention in atrial fibrillation, was used to generate a draft document, which
then underwent three cycles of revision and debate before all panel members
agreed with the consensus statements. RESULTS: Six areas were identified that
included how to identify patients with atrial fibrillation, how to determine
their stroke risk and whether to recommend modification of this risk, and what
management options are available, with practical recommendations on maximising
benefit and minimising risk if anticoagulation is recommended and the reasons why
antiplatelet therapy is no longer recommended. The summary evidence is presented
for each area and simple summary recommendations are highlighted, with areas of
remaining uncertainty listed. CONCLUSIONS: Atrial fibrillation-related stroke is
a major public health priority for most health systems. This practical guidance
can assist generalist community physicians to translate the large evidence base
for this cause of preventable stroke and implement this at a local level.
CI - (c) The European Society of Cardiology 2015.

Langue : ANGLAIS