PREVALENCE OF ATRIAL-FIBRILLATION AND ELIGIBILITY FOR ANTICOAGULANTS IN THE COMMUNITY

Background: Anticoagulants are effective in the prevention of stroke i n atrial fibrillation and flutter (AF). We aimed to find out the preva lence of AF in the UK and to estimate the proportion of patients with AF who might benefit from anticoagulation. Methods We screened with el ectrocardiography a random sample of 4843 people from the community ag ed 65 years and older for AF. Participants with AF had further investi gations to identify risk factors for stroke and contraindications to a nticoagulants. We used three sets of criteria to assess risk and elibi lity for anticoagulation. Findings 228 (4.7%) participants had AF. Acc ording to analyses derived from risk stratifications based on the Stro ke Prevention in Atrial Fibrillation (SPAF) study 61% of these patient s would have benefited from anticoagulation, 49% according to pooled a nalysis of trial results, and 41% according to the inclusion criteria for the SPAF 3 study. Anticoagulants were used by 1114 (23%) of all pa tients and were least used among elderly women, who may be the most li kely to benefit. Echocardiography would be useful to assess the need f or anticoagulation only in patients younger than 75 years with no cont raindications to treatment and no clinical risk factors for stroke. In terpretation: Anticoagulants seem to be underused and misdirected in t reatment of AF, according to various criteria. Efforts to promote and support wider and more appropriate use of anticoagulants would seem to be justified, and should decrease the incidence of stroke amongst eld erly patients.