Please login or register to print this page.

Case Reports, Lead Article

Stroke Association plans AF awareness campaign

The UK Stroke Association is in the process of planning an awareness campaign around atrial fibrillation (AF) and its link to stroke.

Intended to raise awareness and encourage better treatment of AF amongst both clinicians and the public, the campaign will be launched in 2011 with three stated aims:

  • To ensure that primary healthcare professionals (predominantly GPs and practice nurses) are screening, diagnosing and treating AF to optimum levels.
  • To raise awareness of AF as a risk factor for stroke amongst the public.
  • To lobby national policy makers for improvement in and better implementation of guidance around AF detection/treatment.

Efforts will also include an organised advertising campaign on the dangers of AF, targeting the public, and a parliamentary reception in June to spread awareness amongst and gain support from policymakers. The Stroke Association has also carried out a survey of 1000 GPs to gauge clinical awareness levels of the link between the two conditions, and to ascertain their concerns over the current diagnosis, treatment and management of AF – the results will be published early in the new year.

The Stroke Association’s planned campaign will follow on the heels of a report it published recently with the Atrial Fibrillation Association[1] analysing widespread weaknesses in management of the AF/stroke problem. Their report highlights the general under-diagnosis and under-treatment of AF by clinicians, as well as the scant attention given to it by policymakers.

Its authors suggest that despite the dangers and great economic toll of the condition, AF rarely attracts the attention its severity and epidemiology warrants. Based on the results of a clinician survey, they claim that “clinicians do not regard AF as especially life threatening”, despite the immediate, well-recognised dangers posed by stroke itself, indicating that clinicians “may not fully appreciate the strength of the association between stroke and AF” [1] (p.15).

The report refers to a survey conducted by the AF Aware group[2] which found that 31% of UK patients with AF had never seen a cardiologist, a further 24% saw their cardiologist less than once a year, and 35% of patients only saw their GP once a year or less. The report’s authors recommend more thorough scrutiny in AF care, including specialist nurses and clinics for dedicated treatment.

It also evaluates the presence of AF within the NHS’ Quality and Outcomes Framework (QOF) for GPs, stating the need for greater encouragement of monitoring and treatment. The QOF currently rewards practices for producing a register of AF patients and for the percentages, firstly, diagnosed by ECG or a specialist and, secondly, treated with anticoagulants or anti-platelet therapy. However, the report’s authors point out that QOF indicators do not encourage active identification of AF in patients with associated risk factors, such as age or obesity, who may benefit from additional treatment to anticoagulation alone.

The Stroke Association, in collaboration with Stroke Alliance for Europe (SAFE), Atrial Fibrillation Association (AFA) and Sanofi-Aventis, have commissioned two research studies around AF in the past two years. Initially, the Sanofi-sponsored ‘AF Aware’ campaign was launched to highlight differences in information provision for AF patients in Europe. Patients were surveyed about their treatment and the amount and quality of information about AF they were offered, the results of which were then compared with the perceptions of AF healthcare professionals.[3]

As a result of the survey, SAFE and The Stroke Association obtained a larger grant from Sanofi to commission a health economics based study in 2010 about the provision of AF services across Europe, and how they compared, with a particular emphasis on Eastern Europe. The results from this study were very recently presented to the SAFE annual conference in Slovenia. They are also planning further research commissions around AF in 2011, and are currently beginning the process of identifying further gaps and areas of AF research needing further study on a Europe-wide basis.

According to Dr Peter Coleman, Deputy Director of Research, the Association is particularly interested in recent Lancet publications from Professor Peter Rothwell[4, 5, 6, 7] and colleagues in Oxford, who have shown in the OXVASC cohort that patients exhibiting significant variability in their blood pressure may be at significantly higher risk of stroke than patients who have stable hypertension, and that certain blood pressure medications actually promote and increase blood pressure variability. Coleman tells Arrhythmia Watch that the findings “are particularly applicable to people suffering from AF, as it may be that individuals suffering the combination of variable blood pressure and AF could be hugely at risk of stroke”.

The Association also recognises that the fast and reliable diagnosis of AF is a key area for future developments, and have had recent talks with a medical devices manufacturer regarding their wearable ECG monitors. The Stroke Association carries out regular testing of the public in their ‘Know Your Blood Pressure’ campaign, emphasising the importance of getting any palpitations checked by a healthcare professional, but appreciate that infrequent blood pressure monitoring and ECG is unlikely to pick up idiosyncratic AF and that a more focused intervention is required in people who suspect they have AF.

References

  1. ‘Keeping Our Finger on the Pulse: Why Wales Must Address the Personal, Clinical and Economic Impact of Atrial Fibrillation’, Atrial Fibrillation Association & Stroke Association in Wales (2010) http://www.stroke.org.uk/media_centre/press_releases/wales/keeping_our_finger.html
  2. Close the Gap, AF Aware survey (2009)
  3. An international survey of physician and patient understanding, perception, and attitudes to atrial fibrillation and its contribution to cardiovascular disease morbidity and mortality, European Society of Cardiology (2009)
  4. Blood pressure variability and risk of new-onset atrial fibrillation: a systematic review of randomized trials of antihypertensive drugs, Webb AJ, Rothwell PM., (Stroke. 2010 Sep;41(9):2091-3. Epub 2010 Jul 22)
  5. Effects of beta blockers and calcium-channel blockers on within-individual variability in blood pressure and risk of stroke, Rothwell PM, Howard SC, Dolan E, O’Brien E, Dobson JE, Dahlöf B, Poulter NR, Sever PS; ASCOT-BPLA and MRC Trial Investigators, (Lancet Neurol. 2010 May;9(5):469-80. Epub 2010 Mar 11)
  6. Effects of antihypertensive-drug class on interindividual variation in blood pressure and risk of stroke: a systematic review and meta-analysis, Webb AJ, Fischer U, Mehta Z, Rothwell PM., (Lancet. 2010 Mar 13;375(9718):906-15)
  7. Prognostic significance of visit-to-visit variability, maximum systolic blood pressure, and episodic hypertension, Rothwell PM, Howard SC, Dolan E, O’Brien E, Dobson JE, Dahlöf B, Sever PS, Poulter NR., (Lancet. 2010 Mar 13;375(9718):895-905)

Published on: January 13, 2011

Members Area

Log in or Register now.

 For healthcare professionals only
Angina book sky

SEARCH THE SITE

RSS FEED

Subscribe to our RSS feed
home

GET EXCLUSIVE UPDATES

Sign up for our regular email newsletters & be the first to know about fresh articles and site updates.

RECENT COMMENTS

    None Found

ENDORSED BY

  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association
 

You are not logged in

You need to be a member to print this page.
Sign up for free membership, or log in.

You are not logged in

You need to be a member to download PDF's.
Sign up for free membership, or log in.