People with ‘resolved’ AF should stay on anticoagulants: experts

Atrial fibrillation guidelines should be updated to reflect that people with ‘resolved’ atrial fibrillation remain at a significantly high risk of stroke and transient ischaemic attack, public health experts say. 

According to the study authors from the Institute of Applied Health Research at the University of Birmingham in the UK people with a diagnosis of ‘resolved’ atrial fibrillation (AF) should continue to receive anticoagulation therapy, known to reduce the risk of stroke in these patients by about two-thirds.

Their retrospective cohort study involved adults with resolved atrial fibrillation (n=11 1589); people with atrial fibrillation (n=15 059) and controls without atrial fibrillation.  

They found that the rates for stroke or TIA in patients with a diagnosis of ‘resolved’ AF were 60% higher than in patients with no history of AF.

“Even when patients with a subsequent record of recurrent atrial fibrillation were excluded from the analysis, stroke or TIA rates were 45% greater in patients with resolved atrial fibrillation than in those with no history of atrial fibrillation,” they wrote in the paper published in The BMJ.

“Mortality rates were approximately 10% higher in patients with resolved atrial fibrillation than in those with no atrial fibrillation,” they added.

The authors noted that their figures showed that patients with resolved AF were likely to benefit from continued anticoagulant prophylaxis, however records showed that in 2016, for example, treatment rates were 80% lower in patients with a diagnosis of resolved AF than in patients with unresolved AF.

“It is recommended that national and international guidelines are updated to advocate continued use of anticoagulant treatment in patients with resolved atrial fibrillation” the study authors concluded.  

Speaking to the limbic Associate Professor John Amerena, a cardiologist at Barwon Health in Geelong  said that in Australia most cardiologists would recommend that patients with ‘resolved’ AF continue to be treatment with anticoagulation indefinitely if their CHADSVASC score was 2 or above.

“We know that AF often recurs, is often asymptomatic and that these patients are at increased risk of stroke” he said.

He noted that Australian guidelines for the treatment and management of atrial fibrillation are in the final stages of preparation and will be published at the CSANZ conference in Brisbane, Queensland in August later this year.

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