Atrial fibrillation in a primary care population: how close to NICE guidelines are we?

Loo, B; Parnell, Cath; Brook, Gerald J.; Southall, Ed; Mahy, I R

doi:10.7861/clinmedicine.9-3-219

Cited by 5 publications

(7 citation statements)

References 16 publications

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“…AF diagnosis was often corroborated in the patient records, although it was not possible to confirm all AF diagnoses; however, in a sample of 131 patients with AF diagnosed in UK primary care in 2006, 84% were found to have either a primary or secondary care ECG confirmation of their diagnosis 32. Care was taken to exclude patients with ‘AF resolved’.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and treatment of atrial fibrillation in UK general practice from 2000 to 2016

Adderley

Ryan

Nirantharakumar

et al. 2018

Heart

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Section: Discussionmentioning

confidence: 99%

Prevalence and treatment of atrial fibrillation in UK general practice from 2000 to 2016

Adderley

Ryan

Nirantharakumar

et al. 2018

Heart

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“…The use of echocardiography is an important part of management, and in the paper by Loo et al only 44% of the study population underwent an echocardiogram. 8 However, this percentage increases in those who were diagnosed with AF after 2000 and those who had cardiology input from secondary care. This could probably be explained by a better understanding of the management of AF, better educational efforts and, perhaps, a better provision of echocardiography services from secondary care.…”

mentioning

confidence: 96%

“…9,10 When comparing the NICE stroke risk score with the CHADS2 score, Loo and colleagues found that 50% of the patients recruited fell into the 'high-risk' category using the NICE schema, while only 28% of the same patients would be considered to be 'high risk' if the simpler CHADS2 scoring schema was used, despite the latter being published earlier (2001) than the NICE schema. 8 Also, the large number of patients categorised in the intermediate/moderate-risk group by the CHADS2 schema reflects the limitation of the published stroke risk stratification schema in assisting clinicians' antithrombotic therapy decision making. In the recent Stroke in AF working group analysis, the proportion classified as high risk could vary substantially -between 11% and 77% -depending on which schema was used.…”

Section: Box 1 Priorities For Implementation In the National Institumentioning

confidence: 99%

“…Clearly, the article by Loo and colleagues illustrates that AF in general is still relatively poorly managed in primary and secondary care despite well-established principles and protocols. 8 Can the NICE guidelines for the management of AF overcome this issue and ultimately improve patient care? Guidelines are simply recommendations for best practice given the best evidence available at the time.…”

Section: Box 1 Priorities For Implementation In the National Institumentioning

confidence: 99%

“…8 Their study suggests that only 84% of 131 patients with diagnosis of AF had either electrocardiogram (ECG) documentation in primary and/or secondary care. Almost half of the patients with AF were managed in primary care alone and the diagnosis of AF was generally accurate.…”

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confidence: 99%

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Can the NICE guidelines on the management of atrial fibrillation improve its management?

Khoo

Lip

2009

Clinical Medicine

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Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia seen in clinical practice. The incidence of AF increases significantly with advancing age, with the prevalence being 8% for population of age 80 and above. 1 For those who are 40 years and older, the lifetime risk for the development of AF is 1 in 4 in both men and women. 2,3 With an ageing population, an increase in the incidence and prevalence of AF has been reported worldwide. 4,5 Indeed, AF has become such a common problem that it is now described as 'a major epidemic' .Due to the close relationship between AF, stroke and thromboembolism there has been a need for increased caution. Irrespective of applying a rate-control or rhythm-control strategy thromboprophylaxis remains the essential core of any AF management strategy. Given that AF is so common various management guidelines have been published over the last few years. 6,7 In the UK, the evidence-based national guidelines for the management of AF were published by the National Institute for Health and Clinical Excellence (NICE) in June 2006. 7 The methodology for the NICE guidelines differs from other expert consensus-based guidelines in that, following agreement and definition of a scope for the NICE guideline, pertinent questions on AF management are formulated and a formal systematic review undertaken by an information scientist who would retrieve, assess and organise sources of published evidence. The latter is then critically appraised and graded by a health service research fellow and, if needed, a health economist. The synthesised evidence is reviewed and debated by a guideline development group (GDG), which included multidisciplinary representatives from various learned bodies and specialist organisations.Despite the published guidelines for the management of AF, this common arrhythmia remains poorly managed, both in primary and secondary care, with marked variation in the approach to investigation and treatment. Apart from the specific recommendations, the NICE guidelines have highlighted five key priorities for implementation as well as audit criteria and areas for future research (Box 1). The remit of the NICE guideline on AF management was to provide a practical, pragmatic and highly applicable national guideline to the UK clinical setting, which would be applicable for Ͼ80% of AF patients for Ͼ80% of the time. Given this aim, has the publication of these guidelines actually improved AF management?In the current issue of Clinical Medicine, the paper by Loo and colleagues examines existing clinical practice in advance of publication of the NICE guidelines. 8 Their study suggests that only 84% of 131 patients with diagnosis of AF had either electrocardiogram (ECG) documentation in primary and/or secondary care. Almost half of the patients with AF were managed in primary care alone and the diagnosis of AF was generally accurate. The use of echocardiography is an important part of management, and in the paper by Loo et al only 44% of the study population underwent an echocar...

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La gestión del proceso de fibrilación auricular: un abordaje integral

Lapuente

Galindo²,

Goñi³

et al. 2013

Revista de Calidad Asistencial

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Atrial fibrillation in a primary care population: how close to NICE guidelines are we?

Cited by 5 publications

References 16 publications

Prevalence and treatment of atrial fibrillation in UK general practice from 2000 to 2016

Prevalence and treatment of atrial fibrillation in UK general practice from 2000 to 2016

Can the NICE guidelines on the management of atrial fibrillation improve its management?

La gestión del proceso de fibrilación auricular: un abordaje integral

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