European Heart Journal Advance Access originally published online on April 19, 2007
European Heart Journal 2007 28(9):1173; doi:10.1093/eurheartj/ehm058
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Stroke prophylaxis in patients with atrial fibrillation: what can we do about it?: reply
Karolinska Institute/Nacka Hospital Cardiology Clinic
Lasarettsvägen 4
Stockholm,
Sweden
E-mail address: leif.friberg{at}stockholm.bonet.se
We fully agree with Dr Mark Naunton when he argues that educating and disseminating anticoagulation guidelines to general practioners should be of high priority. Unfortunately, Dr Naunton seems to believe that we think education of cardiologists as the main priority. We did not say that. We simply concluded that ‘it is urgent to increase the awareness of the need for adequate stroke prophylaxis in AF patients’.
However, we do believe it is important to increase the awareness about stroke risk stratification and guideline recommendations in hospital doctors as well. Most AF-patients do sooner or later turn up at a hospital. The prescriptions and recommendations from the hospital specialists has great influence on the general practitioners in the area to whom the patients are referred from the hospital.
The study population in the SCAF-study1 consisted of hospital patients. The results concern prescription behaviour of hospital doctors. We showed that hospital practices are far from perfect. If any one might have believed that all was well at the hospitals and that the general practitioners were the bad guys, they were utterly mistaken.
We have got a credibility problem. How do we make general practioners care about guidelines2,3 if hospital specialists don't? Cardiologists and internists together have to show, in daily practical decisions, that stroke prophylaxis and guideline adherence in AF is important, otherwise failure is certain.
Thus, we firmly believe that efforts to increase the awareness about stroke prophylaxis is as important at the hospital as it is at the general practitioners office.
References
- Friberg L, Hammar N, Ringh M, Pettersson H, Rosenqvist M. Stroke prophylaxis in atrial fibrillation: who gets it and who does not? Report from the Stockholm Cohort-study on Atrial Fibrillation (SCAF-Study). Eur Heart J (2006) 27:1954–1964.
[Abstract/Free Full Text] - Fuster V, Ryden L, et al. ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to develop guidelines for the management of patients with atrial fibrillation) developed in collaboration with the North American Society of Pacing and Electrophysiology. Eur Heart J (2001) 22:1852–1923.
[Free Full Text] - Fuster V, Ryden L, et al. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: full text: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 guidelines for the management of patients with atrial fibrillation) developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Europace (2006) 8:651–745.
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