According to research published in BMJ Open, UK doctors are still under-treating abnormal heart rhythm (atrial fibrillation -AF), one of the major stroke risk factors, despite substantial improvements in stroke prevention made over the past decade, lower incidence rates and deaths. In order to cut preventable deaths and disability from stroke, the NHS prioritized AF treatment.

Researchers evaluated stroke data obtained from the General Practice Research Database (GPRD) from 1999 to 2008 which GPRD comprises anonymous long-term data on three million UK primary care patients. They established that over 32,000 adults suffered a stroke during the study period of which one in seven, i.e. 15% were fatal.

Findings revealed that compared with men, women were more likely to die of stroke even when age was taken into consideration. On average women were 77 years old when suffering their first stroke whilst men were aged 71 years.

According to the data, researchers observed substantial improvements in the number of new stroke incidents and subsequent survival, and despite an increase of 12.5% in stroke prevalence, the number of new incidents decreased by almost a third (30%) over the 10 years, from 1.48 per 1,000 person years in 1999 to 1.04 in 2008. The decrease was even larger (42%) in people aged 80 years or older who represent the highest risk group for stroke.

Mortality rates within 56 days following a first stroke almost halved, dropping from 21% in 1999 to 12% in 2008, which is a fall from one in five people to almost one in ten people respectively.

These improvements were side-by-side with the consistent rise in prescriptions for preventive drugs, especially medication for lowering cholesterol levels and high blood pressure, both risk factors for stroke. However, the findings also revealed that doctors under-treat patients with atrial fibrillation.

Approximately one out of ten patients was diagnosed with AF before suffering their first stroke. This group of people had a substantially higher mortality risk due to stroke compared with those without AF. Doctors prescribed preventative anticoagulant (blood thinning agents) to just one in four patients with AF, with no evidence of targeting more serious AF.

According to the research, women had a substantially higher risk of having serious AF than men, but had a lower chance of receiving anticoagulant therapy. Whilst 29% of men were prescribed with AF only 22% of women received the therapy. Although both men and women with AF after a first stroke were more likely to be prescribed anticoagulants, the study revealed that figures increased from 29% to 48% of men, yet only rose from 22% to 35% of women.

The researchers support the view that the risk factors for stroke are being tackled a lot more effectively by primary care doctors, however, they say:

“There is a clear suggestion that risk stratification is not yet optimal, particularly in relation to patients with AF.”

Written by Petra Rattue