Education And Debate


BMJ 1996; 312 doi: (Published 20 January 1996) Cite this as: BMJ 1996;312:175
  1. Gregory Y H Lip,
  2. D Gareth Beevers,
  3. John R Coope

    General practice

    Despite the considerable interest in atrial fibrillation in epidemiological and hospital studies, little information exists on the prevalence and management of atrial fibrillation in general practice.

    In a recent audit of a general practice list of about 10000 patients, we found 67 patients who were currently in atrial fibrillation or who were known to have had past episodes of the arrhythmia.

    Role of general practitioner

    • To identify patients with new onset atrial fibrillation

    • To assess thromboembolic risk and to start early treatment with antithrombotic drugs—warfarin will be needed for most patients, while aspirin may be suitable for patients aged <65 years with no cardiac risk factors or structural heart disease

    • To help to monitor treatment with anticoagulants

    • To refer appropriate patients to a cardiologist for further assessment (including echocardiography) and consideration of cardioversion

    • To be aware of potential drug interactions and toxicity with antiarrhythmic drugs and anticoagulants

    This prevalence increased with age, rising from 1.5% in people in their 60s to 8% in those aged over 90. A third of the 67 patients had paroxysmal atrial fibrillation. Only two thirds were currently receiving anticoagulant treatment, and an echocardiogram had been obtained in only a third. Of the 30 patients under 75 years, 10 had mitral valve disease, while only one patient aged over 75 had mitral valve disease.

    A general practitioner typically has 10-15 patients with atrial fibrillation on his or her list

    From the stroke prevention in atrial fibrillation study, major clinical risk factors for stroke and thromboembolism were congestive heart failure, hypertension, and previous thromboembolism. We found that at least one of these risk factors was present in three quarters of patients seen in general practice with atrial fibrillation (and in 84% of those aged over 75).

    Prevalence of atrial fibrillation by age in a general practice population.

    The general population is …

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