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New guidelines for atrial fibrillation

Issued by the National Institute for Clinical Excellence
 

New guidelines aim to increase the identification and treatment of atrial fibrillation (AF) a 'hidden disease' that is the commonest sustained cardiac rhythm disorder.

The condition is important to diagnose early as it is a major risk factor for stroke - people with AF have a one in twenty chance of having a stroke. The new guidance will help GPs and other healthcare professionals recognise and treat AF.

The guideline, produced by the National Institute for Health and Clinical Excellence (NICE) and the National Collaborating Centre for Chronic Conditions (NCC-CC) at the Royal College of Physicians, contains evidence-based guidance on the diagnosis and management of AF as it occurs in emergency, primary, post-operative and secondary care, and also gives recommendations for referral to specialist services.

AF occurs when the electrical impulses controlling the heart rhythm become disorganised, so that the heart beats irregularly and, occasionally, too fast and so cannot efficiently pump blood around the body. This might cause symptoms such as palpitations, chest pain or discomfort, shortness of breath, dizziness and fainting. Severe symptoms can be life-threatening and require immediate treatment. However, many people with AF are asymptomatic, that is they have no obvious symptoms.

People with AF are at higher risk of developing blood clots and subsequent stroke - however, the risk of stroke can be substantially reduced by appropriate use of antithrombotic therapy (e.g. warfarin).

Part of the guidance deals with self-monitoring of anticoagulation therapy and states:

1.9.1 Anticoagulation self-monitoring

1.9.11 In patients with AF who require long-term anticoagulation, self-monitoring should be considered if preferred by the patient and the following criteria are met:

1. The patient is both physically and cognitively able to perform the self-monitoring test, or in those cases where the patient is not physically or cognitively able to perform self-monitoring, a designated carer is able to do so
2. An adequate supportive educational programme is in place to train patients and/or carers
3. The patient's ability to self-manage is regularly reviewed
4. The equipment for self-monitoring is regularly checked via a quality control programme.

If you have atrial fibrillation and would like to consider self-monitoring your INR you should discuss this with your clinic. You should also ask your GP if he will prescribe the reagent testing strips. These have been available on prescription since May 2002.

For further information go to www.nice.org.uk