RCPE Press Release

01 March 2012

Medical experts from around the UK will be gathering in Edinburgh today (1 March 2012), at an event organised by the Royal College of Physicians of Edinburgh (RCPE) [1], to agree a course of action aimed at preventing almost 2000 avoidable stroke deaths per year throughout the UK.

The event will focus on improving detection and treatment of atrial fibrillation, a common heart condition [2], which can be easily treated, but is a major risk factor in the development of stroke and contributes to 15% of stroke cases and deaths. Despite the availability of effective treatment options, evidence suggests that up to 50% of patients eligible for treatment are not receiving this. In many cases the initiation of appropriate treatment could significantly reduce the risk of developing a stroke and it has been estimated that as many as 1987 premature deaths could be avoided in the UK (179 in Scotland) every year through more effective detection and treatment of atrial fibrillation [3].

Historical treatment of atrial fibrillation has involved the use of anti-coagulant drugs, such as warfarin, which thin the blood and prevent the development of potentially fatal blood clots. While such drugs have had accompanying side effects [4] and would not be appropriate for some patients, they could be used effectively and safely in the treatment of approximately 50% of patients with atrial fibrillation. Of these patients, half are not receiving treatment. Uncertainty continues regarding why this is the case, but this is thought to be influenced by a number of factors including the fact that atrial fibrillation can be a ‘silent’ illness, a lack of awareness regarding symptoms, and negative perceptions regarding treatment options. A recent national audit report has also confirmed the under-use of warfarin for high-risk patients and its inappropriate use for low-risk patients. [5]

In parallel, there has been uncertainty regarding the effectiveness and safety of other historical drug treatments for atrial fibrillation including aspirin which has often been used as an alternative to warfarin. The evidence has evolved in this area and it is now much clearer that the use of aspirin is less effective and also not any safer than warfarin, particularly in elderly people.

Recently the potential for a more radical change in the treatment of atrial fibrillation and prevention of stroke has arisen with the development of a new generation of blood thinning drugs which have far fewer potential side effects. Previously, only high-risk patients were treated with warfarin, an “inconvenient” drug, and there is now an opportunity to shift the focus away from this treatment approach on to identifying low risk patients, who do not require such treatment, and can instead be offered one of the newer drugs. All patients with one or more stroke risk factors should now be considered for this treatment. This strategy will form a major shift in the prevention of stroke and will potentially have a much greater impact on reducing the devastating effects of stroke. It‘s success will, however, depend heavily upon improved medical and patient understanding of the treatment options and risks involved.

Against this background, the RCPE has convened a UK-wide meeting to reach consensus on how to improve treatment for atrial fibrillation and provide much-needed advice to doctors.

Prof Gregory Lip, Royal College of Physicians of Edinburgh (and Professor of Cardiovascular Medicine, University of Birmingham), said,

“Stroke is a devastating illness which kills over 50,000 people in the UK every year and leaves many more with severe disability and greatly reduced quality of life. Some patients who have experienced a stroke have likened this to a fate worse than death. As doctors, it is vital that we recognise that many of these deaths could be avoided if we improve awareness, diagnosis and treatment of a common heart condition which is a major risk factor in developing stroke.

“Atrial fibrillation is a treatable illness and need not result in stroke. A new range of drug treatments offer great potential for revolutionising the way in which we treat atrial fibrillation, target patients and reduce their likelihood of having a stroke.”

Contact: Graeme McAlister on 07733-263453 or 0131-247-3693

Notes to Editors

[1] The RCPE UK Consensus Conference on Atrial Fibrillation will be held on 1 and 2 March 2012 (9.00am – 5.00pm) at the RCPE, 9 Queen Street, Edinburgh.

[2] Atrial fibrillation is the most common, sustained, heart disorder. We all have a 1 in 4 lifetime chance of developing it. It arises from an irregular heartbeat and presents symptoms of palpitations, chest pain, breathlessness and dizziness. It is estimated to affect 2% of the UK population at any one time. Exercise tolerance and quality of life are both decreased in patients with atrial fibrillation.

[3] RCPE estimates derived from latest national data.

[4] Side effects and complications of traditional anti-coagulant (blood thinning) drugs, of which warfarin is the main, include –

  • risks of bleeding complications;
  • interactions with other prescription drugs;
  • interactions with certain foods (including cranberry juice, garlic and foods high in vitamin k including broccoli, spinach and and soy beans);
  • interactions with herbal remedies; and
  • negative patient perceptions given that warfarin was originally adapted and developed from an early form of rat poison.

[5] Cardiology Services, Audit Scotland, February 2012

The RCPE is a professional membership organisation with over 10,000 Fellows and Members worldwide, primarily hospital specialists.