TY - JOUR T1 - Research into practice: management of atrial fibrillation in general practice JF - British Journal of General Practice JO - Br J Gen Pract SP - 540 LP - 542 DO - 10.3399/bjgp14X682057 VL - 64 IS - 627 AU - David A Fitzmaurice AU - FD Richard Hobbs Y1 - 2014/10/01 UR - http://bjgp.org/content/64/627/540.abstract N2 - Atrial fibrillation (AF) is the commonest cardiac arrhythmia, characterised by an irregularly irregular pulse, and an absence of P waves on electrocardiogram (ECG). It is a major independent risk factor for thromboembolic disease, particularly stroke with which it is associated with a fivefold increase in risk.Prevalence data for AF have been notoriously difficult to ascertain with estimates of 5–10% in the population aged ≥65 years. A review of four large community-based studies of AF suggested that the overall community prevalence in the US is 0.89%. Our primary care studies in the UK indicate that over 10% of people aged >75 years experience AF1 and 4% of people with AF are undiagnosed.2 Prevalence increases sharply with age: 2.3% of people aged ≥40 years; 5.9% of people aged ≥65 years, and 10% of those >80 years. The vast majority (84%) of people with AF are ≥65 years.AF is a particularly important risk factor for stroke in older people: while 15% of all strokes are associated with the arrhythmia, it is associated with 36% of strokes in people aged >80 years. The incidence of new cases of AF in people aged ≥65 years is of the order of 1% per annum.The risk of stroke can be reduced through the use of anticoagulant agents; for example, warfarin has been found to be consistently effective for the prevention of ischaemic stroke with a reduction in the incidence of all strokes of 68% (95% confidence interval = 50% to 79%), representing an absolute annual reduction of 3.1% (P<0.001). Newer agents (dabigatran, rivaroxaban, and apixaban) have been found in large randomised controlled trials (RCTs) to be at least as effective and are now to be considered alongside warfarin when deciding on anticoagulation.3Despite the robust evidence base for effective stroke … ER -