SERVICE PROVISION AND USE OF ANTICOAGULANTS IN ATRIAL-FIBRILLATION

Several large trials have shown that the risk of stroke in patients wi th non-valvar atrial fibrillation is reduced by treatment with warfari n. Implementing this research evidence requires not only an understand ing of the trials' results and of the changes that they imply for clin icians' treatment decisions but also an appreciation of the organisati on, quantity, and quality of services required to support these change s. Understanding of these implications is crucial for developing servi ces that allow changes in practice to produce reductions in stroke inc idence while minimising the risks of treatment. This article considers the developments in service provision that will probably be required to support the changes in clinical practice suggested by the trials' r esults. These services will be provided largely by doctors, and their development has implications for doctors in both primary and secondary care.