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Patients with ‘cured’ AF should still be on anticoagulation



Patients who have had their AF resolved remain at a high risk of stroke and should still be treated with anticoagulants.

Patients who have had their AF resolved remain at a high risk of stroke and should still be treated with anticoagulants.

New research in The BMJ has found that patients with AF marked as ‘resolved’ had a 45% increased risk of suffering a stroke when compared to patients without any history of AF.

Absolute incidence rates were 12.1 per 1,000 person years for those with resolved AF, and 7.4 per 1,000 person years for patients without AF.

The research looked at records from a UK primary care database for just over 11,000 patients with a ‘resolved AF’ code and compared them to just over 22,000 controls who did not have AF.

The researchers suggested in the paper that the findings of the study have important implications for national guidelines.

They said: ‘Patients with a diagnosis of resolved atrial fibrillation have increased as a proportion of patients with atrial fibrillation. These patients would benefit from continued anticoagulant prophylaxis, but treatment rates in this group are extremely low. It is recommended that national and international guidelines are updated to advocate continued use of anticoagulant treatment in patients with resolved atrial fibrillation.’

Study author Professor Tom Marshall, professor of public health and primary care at the University of Birmingham, commented: ‘The problem is that ‘AF resolved’ means that patients are no longer followed up and within 3 months 90% have stopped treatment.

‘The simplest solution would be to identify patients with ‘AF resolved’ codes, offer them anticoagulants again and put them back on the AF register for follow up and ongoing anticoagulation.

‘But this also needs action to change QOF because QOF does not include patients with ‘AF resolved’. This is not anybody’s fault. Until our paper was published we didn’t realise that patients with an ‘AF resolved’ code were still at the same risk of stroke.’

BMJ 2018, online 11 May