Community-based study of atrial fibrillation and stroke prevention.

The benefits of anticoagulation and antiplatelet agents for stroke prevention in atrial fibrillation (AF) have been established. There is little data on the use of this form of stroke prevention in patients with AF in Ireland. To determine whether adequate stroke prevention measures are taken regarding anticoagulation and aspirin use for patients in the community with chronic AF. Audit of general medical services (GMS) patients with atrial fibrillation in two Dublin general practices. A total of 70 patients with AF were identified from 2684 GMS patients in the two practices: contraindications to anticoagulation were established in 26 of these. In those for whom warfarin was indicated, 21 of 44 (47%) were not anticoagulated. In those not anticoagulated and where aspirin was not contra-indicated, 20 of 42 were not on aspirin. Our study found that almost one third of patients with AF could be anticoagulated but were not, and the alternative of aspirin was only used in just over one half of patients. This represents a lost opportunity for stroke prevention. Various approaches should be explored to remedy this.