Atrial fibrillation

The CVD prevention pathway indicates that 30% of people with Atrial Fibrillation (AF) are undiagnosed. Of those patients with a diagnosis of AF, half are untreated or poorly controlled. It is increasingly important to make sure people are identified and treated in a timely way and nursing staff are key in helping this to happen.

Atrial Fibrillation Indicators for General Practice developed by NICE in 2017, suggest that patients with coronary heart disease, heart failure, hypertension, diabetes, CKD, Peripheral Arterial Disease, or stroke/TIA are at a greater risk of having AF and AF is a contributory factor in 1 in 5 strokes. 

Of those people with AF who do have a stroke, evidence indicates that this is more severe than in those patients without AF, requires longer hospital stays, involves greater disability and is associated with higher rates of recurrence and mortality (Atrial Fibrillation Association, 2016). 

NICE (2017) advocates that regularly checking for an irregular pulse can help ensure people do not remain undiagnosed.   

The Sentinel Stroke National Audit programme suggests that if everyone with AF were treated with anticoagulants appropriately then about 6,000 strokes would be prevented each year. 

• to help assess the risk of stroke, NICE guidance on atrial fibrillation recommends the use of CHA2DS2-VASc score.

Once AF is established appropriate risk stratification is required. NICE (2014) recommend the use of CHA2DS2VASc. For patients already receiving anticoagulants the HAS-BLED tool is useful. More details about these tools, see: CHADS-VASC / HAS-BLED / EHRA atrial fibrillation risk score calculator.

The GRASP-AF tool was developed to assist General Practice in the management and care of patients with AF. For more information, see: GRASP-AF.

The prevalence of atrial fibrillation has been increasing steadily and healthcare professionals need to be aware of the modifiable risk factors for developing AF including:

• hypertension
• ischaemic heart disease
• heart failure
• dverse lifestyle, for example smoking, excess alcohol and unhealthy diet
• diabetes mellitus
• sleep apnoea

The NHS Health Check offers an opportunity to prevent and detect early signs of heart disease, kidney disease, type 2 diabetes and dementia. Stroke prevention has become an important issue for all healthcare professionals, particularly with the increasing prevalence of atrial fibrillation. Detection of an irregular pulse should therefore be followed up appropriately to reduce the risks.