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Non-vitamin K antagonist oral anticoagulants and atrial fibrillation guidelines in practice: barriers to and strategies for optimal implementation.

Camm AJ, Pinto FJ, Hankey GJ, Andreotti F, Hobbs FD, Writing Committee of the Action for Stroke Prevention allian - Europace (2015)

Bottom Line: However, despite this guidance, registry data indicate that anticoagulation is still widely underused.With a focus on the 2012 update of the European Society of Cardiology (ESC) guidelines for the management of AF, the Action for Stroke Prevention alliance writing group have identified key reasons for the suboptimal implementation of the guidelines at a global, regional, and local level, with an emphasis on access restrictions to guideline-recommended therapies.Following identification of these barriers, the group has developed an expert consensus on strategies to augment the implementation of current guidelines, including practical, educational, and access-related measures.

View Article: PubMed Central - PubMed

Affiliation: Department of Clinical Cardiology, St George's University of London, London SW17 0RE, UK jcamm@sgul.ac.uk.

No MeSH data available.


Related in: MedlinePlus

Estimates of the prevalence of AF.4–8 *Based on data from a single community study.
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EUV068F1: Estimates of the prevalence of AF.4–8 *Based on data from a single community study.

Mentions: In 2012, stroke was estimated to have contributed to the deaths of ∼6.7 million people worldwide, accounting for nearly 12% of all deaths.1 Stroke causes permanent disability in nearly 5 million people each year.2 Atrial fibrillation (AF) is a significant independent risk factor for stroke, associated with an approximately five-fold excess in risk, but is much less well recognized than, for example, hypertension, for which the excess stroke risk is three-fold.3 In addition, unlike most other cardiovascular risk factors for stroke, the pivotal Framingham Study found an increase in attributable risk due to AF from 1.5% in individuals aged 50–59 years to 23.5% for those aged 80–89 years.3 Atrial fibrillation is the most common sustained cardiac arrhythmia and represents a global problem (Figure 1).4–8 Patients with AF are five times more likely to have a stroke than the general population.3 Atrial fibrillation-related strokes are almost twice as likely to be fatal and, in survivors, cause severe disability, increase the length of hospital stay and decrease the likelihood of patients returning to their own home, compared with non-AF-related strokes.9,10 Atrial fibrillation-related strokes have also been associated with significantly higher mean direct costs per patient than non-AF-related strokes.11 However, AF-related strokes can be prevented and their impact minimized by effective management strategies including increased detection of AF, adherence to stroke prevention guidelines and anticoagulant use in at-risk patients. Left atrial appendage occlusion may also have a role in patients who are unable to receive long-term anticoagulant management, but it is not a recommended alternative to anticoagulation per se.12Figure 1


Non-vitamin K antagonist oral anticoagulants and atrial fibrillation guidelines in practice: barriers to and strategies for optimal implementation.

Camm AJ, Pinto FJ, Hankey GJ, Andreotti F, Hobbs FD, Writing Committee of the Action for Stroke Prevention allian - Europace (2015)

Estimates of the prevalence of AF.4–8 *Based on data from a single community study.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4482288&req=5

EUV068F1: Estimates of the prevalence of AF.4–8 *Based on data from a single community study.
Mentions: In 2012, stroke was estimated to have contributed to the deaths of ∼6.7 million people worldwide, accounting for nearly 12% of all deaths.1 Stroke causes permanent disability in nearly 5 million people each year.2 Atrial fibrillation (AF) is a significant independent risk factor for stroke, associated with an approximately five-fold excess in risk, but is much less well recognized than, for example, hypertension, for which the excess stroke risk is three-fold.3 In addition, unlike most other cardiovascular risk factors for stroke, the pivotal Framingham Study found an increase in attributable risk due to AF from 1.5% in individuals aged 50–59 years to 23.5% for those aged 80–89 years.3 Atrial fibrillation is the most common sustained cardiac arrhythmia and represents a global problem (Figure 1).4–8 Patients with AF are five times more likely to have a stroke than the general population.3 Atrial fibrillation-related strokes are almost twice as likely to be fatal and, in survivors, cause severe disability, increase the length of hospital stay and decrease the likelihood of patients returning to their own home, compared with non-AF-related strokes.9,10 Atrial fibrillation-related strokes have also been associated with significantly higher mean direct costs per patient than non-AF-related strokes.11 However, AF-related strokes can be prevented and their impact minimized by effective management strategies including increased detection of AF, adherence to stroke prevention guidelines and anticoagulant use in at-risk patients. Left atrial appendage occlusion may also have a role in patients who are unable to receive long-term anticoagulant management, but it is not a recommended alternative to anticoagulation per se.12Figure 1

Bottom Line: However, despite this guidance, registry data indicate that anticoagulation is still widely underused.With a focus on the 2012 update of the European Society of Cardiology (ESC) guidelines for the management of AF, the Action for Stroke Prevention alliance writing group have identified key reasons for the suboptimal implementation of the guidelines at a global, regional, and local level, with an emphasis on access restrictions to guideline-recommended therapies.Following identification of these barriers, the group has developed an expert consensus on strategies to augment the implementation of current guidelines, including practical, educational, and access-related measures.

View Article: PubMed Central - PubMed

Affiliation: Department of Clinical Cardiology, St George's University of London, London SW17 0RE, UK jcamm@sgul.ac.uk.

No MeSH data available.


Related in: MedlinePlus