TY - JOUR T1 - Atrial fibrillation and stroke prevention: where we are and where we should be JF - British Journal of General Practice JO - Br J Gen Pract SP - 260 LP - 261 DO - 10.3399/bjgp18X696257 VL - 68 IS - 671 AU - Nicholas R Jones AU - FD Richard Hobbs AU - Clare J Taylor Y1 - 2018/06/01 UR - http://bjgp.org/content/68/671/260.abstract N2 - Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. There are around 1 million people in England with diagnosed AF and an estimated further 425 000 undiagnosed.1 Given changing demographic factors and improved survival rates for comorbid cardiovascular conditions, prevalence is expected to increase significantly. By 2030, a predicted one in four middle-aged adults will have developed AF.2 AF is associated with a five-fold increase in stroke risk, and AF-related strokes are associated with a greater risk of mortality and long-term disability compared with other stroke subtypes. Yet this risk is largely modifiable with anticoagulation, which is proven to reduce ischaemic stroke risk by 65%.2Given the potential benefit in terms of costs and patient outcomes, implementation of anticoagulation is a key target for the NHS. In September 2017, Sir Bruce Keogh, as Medical Director of NHS England, launched the ‘Size of the Prize’ initiative, which highlights opportunities for cardiovascular disease prevention in each sustainability and transformation partnership (STP) area. He suggested that improvements in anticoagulation and cardiovascular disease management could prevent 14 000 strokes across England over a 3-year period. It is usually possible to diagnose and treat AF without the need for specialist resources, meaning changes in service delivery must take place in primary care if these targets are to be achieved. How effectively are anticoagulation guidelines currently implemented and what barriers remain to further improvement?Scoring systems are recommended to help decide which patients are likely to benefit from anticoagulation, balancing the related reduction in ischaemic stroke risk against an increased bleeding risk. The most recent National Institute for Health and Care Excellence (NICE) AF guideline recommends using the CHA2DS2-VASc score to predict ischaemic stroke risk, in place of the previous CHADS2 score.3 Limitations existed with CHADS … ER -