Background Atrial fibrillation (AF) is the most common cardiac arrhythmia that affects 60 million people worldwide. Limited evidence on AF management exists from low- and middle-income countries and none from Sri Lanka. We aimed to investigate the existing AF care pathway and patients’ perception on AF management to identify barriers and enablers for optimal AF care in Northern Province, Sri Lanka. Methods A rapid evaluation was undertaken with use of qualitative methods. Local healthcare providers (HCPs) mapped the intended pathway of care for AF patients which was then explored and annotated through 12 iterative sessions with additional HCPs. Topics of inefficiencies identified from the finalised map were used to guide focus group discussions (FGDs) with AF patients. AF patients who were attending the anticoagulation clinic at the only tertiary hospital in Northern Province were recruited and invited to participate using purposive sampling. The topic guide was developed in collaboration with local clinicians and qualitative experts. FGDs were conducted in the native Tamil language and all sessions were recorded, transcribed verbatim and thematically analysed using a deductive approach. Results The mapped pathway revealed inefficiencies in referral, diagnosis and ongoing management. These were explored through three FGDs conducted with 25 AF patients aged 25 to 70 years. Two key themes that contributed to and resulted in delays in accessing care and ongoing management were health seeking behaviours and atomistic healthcare structures. Four cross-cutting sub-themes identified were decision making, paternalistic approach to care, cost impacts and lifestyle impacts. These are discussed across 10 unique categories with consideration of the local context. Conclusions Strengthening primary healthcare services, improving public health literacy regarding AF and building patient autonomy whilst understanding the importance of their daily life and family involvement may be advantageous in tackling the inefficiencies in the current AF care pathway in Sri Lanka.

Aim To investigate the association between medication use and long‐term all‐cause mortality in a Brazilian stroke cohort. Methods Both ischemic and hemorrhagic stroke were evaluated. Medication use was assessed as: never, only pre‐stroke, only post‐stroke, and continuous use. We evaluated anti‐hypertensives, anti‐diabetics, lipid‐lowering drugs, anti‐platelets, and anti‐coagulants. Cox regression models were adjusted for sociodemographic and cardiovascular risk factors. Results Among 1173 incident stroke cases (median age: 68; 86.8% were ischemic, 70% first‐ever stroke), medication use was low (overall: 17.5% pre‐stroke, 26.4% post‐stroke, and 40% were under continuous use). Anti‐hypertensives and anti‐platelets (aspirin) were the continuous cardiovascular medications used most often, at 83.5% and 72%, respectively, while statins (39.7%) and anti‐diabetics (31.3%) were the least used. Medication use (pre‐stroke, post‐stroke and continuous use) was associated with a reduction in all‐cause mortality risk, particularly among those under continuous use (multivariable hazard ratio, 0.52; 95% confidence interval (CI), 0.46–0.66) compared with never‐users. Among ischemic stroke patients, this effect was similar (multivariable hazard ratio, 0.52; 95% CI, 0.40–0.68). No significant associations were evident among hemorrhagic stroke patients. Conclusions The risk of all‐cause mortality was reduced by 48% among those with ischemic stroke under continuous use of medications. Secondary prevention should be emphasized more strongly in clinical practice. Geriatr Gerontol Int 2022; 22: 715–722.