Filling the patient-safety gaps in atrial fibrillation
Cardiology Important strides have been made in the diagnosis of atrial fibrillation in primary care, but some patients still fall short of getting the right treatment, says Dr Matt Kearney.
While diagnosis of atrial fibrillation has recently improved at primary care level, some estimated 18-20% of patients are still not taking the anti-coagulants they need to manage the condition.
Reasons for this are varied and complex. Many older patients who still associate warfarin with rat poison can be reluctant to take the drug, while the frequent blood tests that warfarin requires can act to deter many others.
Newer anti-coagulants (the NOACs and DOACs) are increasingly being used to treat atrial fibrillation and, as they have the advantage of not requiring blood tests for routine anticoagulation monitoring, patients find them easier to use.
When treating frailer patients with atrial fibrillation, GPs concerned about risk factors will sometimes pursue a more cautious approach, either failing to prescribe anticoagulants altogether or to treat instead with aspirin.
While aspirin is no longer recommended as a blood thinner for atrial fibrillation patients, emerging evidence also suggests that the benefits of anticoagulation treatment almost always outweigh the potential dangers of a bleed.
Shared decision making
For these reasons and more, sharing decision making about anticoagulation treatment is key to ensuring informed choice with patients, and a number of tools have been developed of late to facilitate exactly this.
The initiative is supported by the presence of more pharmacists in GP practices who have been placed in charge of managing patients’ anticoagulation treatment, as well as taking pulse checks.
As time and effort needs to be put into getting patients on the right dosage of anticoagulants if the treatment is to prove maximally effective, it’s a task that pharmacists are well placed to do.
Primary care practitioners who are under-confident in diagnosing atrial fibrillation—often if a patient’s condition is intermittent, for example—may benefit from upskilling. While more efficient treatment pathways are needed in areas where unwarranted variation is an issue.
Between presenting with the condition and securing the right medication is a time of very high risk for patients. By putting new measures in place though, better outcomes can be realised.
EDX/18/0302 June 2018