Doctors advised against aspirin for patients with irregular heart beats. NICE said on on the 18th June 2014 that anticoagulants, not antiplatelets like aspirin, could avert a large number of strokes.

In UK it could avert 7,000 strokes and 2,000 deaths a year. Aspirin should no longer be used to try to prevent strokes in people with a common heart rhythm disorder, atrial fibrillation (AF). Patients with atrial fibrillation are adviced by the National Institute for Health and Care Excellence (NICE) to see their GP to discuss alternative medication or catheter treatment of heart rhythm.

How common is atrial fibrillation and what is it?

It’s quite common, particularly in older people. Atrial fibrillation causes an irregular, sometimes fast pulse because electrical impulses controlling the heart’s natural rhythm lose co-ordination. It can cause palpitations (fast and irregular heartbeats) and leave sufferers tired and breathless, although some people have no symptoms at all. A normal heart rate should be between 60 and 100 beats a minute when you’re resting, and is regular.

You can measure your heart rate by feeling the pulse in your wrist or neck. In atrial fibrillation, the heart rate may be over 140 beats a minute, although it can be any speed. The main difference between a normal rhythm and atrial fibrillation is that you are unable to predict when the next heart beat will come along, as heart rate is irregular.

Commissioners perspective on AF

AF is the most frequent cardiac rhythm disorder and present a considerable public health burden in the next decades due to the aging population. AF results in an 5-fold increase in risk of stroke.

Patient’s perspective on AF

Quality of life is impaired in the majority of patients with AF. Recommendations for treatment
usually place a high value on the decision of individual patients to balance relief of symptoms and improvement in Quality of Life.

A patient reported outcomes questionnaires – Atrial Fibrillation Effect on QualiTy-of-Life (AFEQT) is a valid. reliable and sensitive outcome to clinically follow progress in patients with AF (Am Heart J 2013,166,381-87.e8.), as a tool for disease management, and as a potential marker of healthcare quality.

The new assessment tools will have a central role in true advancement of therapies and treatment guidelines for AF (Europace: European Pacing, Arrhytmias, and Cardiac Electrophysiology, 2014, Jun; 16(6): 787-96).

Providers perspective on AF and prevention of stroke

New oral anticoagulants (NOAC) have shown benefits for health-related quality of life in AF patients (Int.J.Med.Sci., 2014,11(7),680-84), and presents as an alternative to conventional treatment in the prevention of stroke in AF patients as it obviates the periodical monitoring.

NOAC appears to be cost-effective relative to warfarin (Stroke, 2013,44,1676-1681) Both treatment controlling heart rate and heart rhythm improve quality of life in AF.

Treatment controlling heart rate

The choice of drug therapy depends on an eventual concommitant heart disease (Canadian J. Cardiology, 27, 2011, 47-59).

Treatment controlling heart rhythm

A minimally invasive catheter procedure – radiofrequency catheter ablation (RFA) of can ablate, i.e. remove or melt away an unwanted part of a deranged electrical control system at the top of the heart (AV node). RFA can decrease subjective symptoms of AF and improved quality-of-life scores compared with medical therapy.

European centers mainly perform RFA in relative young patients with AF that does not respond adequately to drug treatment and where patients have no or minimal heart disease (J. Cardiovasc. Electrophysol., 2014, June 2). But as patient reported outcome measures (PROMs), such as AFEQT, becomes more predominant in disease mangement of AF the guidelines and patients preferences may change the preferred way of treatment and not include age in decision making.