Medical Experts Call on Scottish & UK Governments to Introduce National Screening Programme to Cut Stroke Deaths

RCPE Press Release

05 March 2012

A high-level meeting of over 120 leading stroke specialists from around the UK, convened by the Royal College of Physicians of Edinburgh (RCPE), has recommended that the Scottish and UK Governments should urgently introduce national screening programmes aimed at reducing the number of strokes and premature deaths caused by stroke.

The meeting, the RCPE UK Consensus Conference on Atrial Fibrillation [1], was convened to identify methods of improving diagnosis and treatment for atrial fibrillation (AF), a common heart condition [2] in which sufferers are 5 times more likely to develop a stroke and be at risk of premature death, with the risk factors increasing with age. AF can be easily treated with anti-coagulant medication (blood-thinning drugs) and it has been estimated that over 5000 strokes and 2000 deaths could be prevented in the UK (including 500 strokes and 180 deaths in Scotland) every year by improving treatment of AF. However AF does not always display symptoms and as a consequence is under-recognised. Even when identified by doctors it is often under-treated and evidence suggests that up to 50% of patients eligible for potentially life-saving treatment are not receiving this.

Against this background, the RCPE convened a two-day meeting during which experts reviewed the current evidence and produced much needed clinical guidance for the NHS throughout Scotland and the UK. The main recommendations within the RCPE UK Consensus Statement on Atrial Fibrillation, produced at this event, include –

• National screening programmes for AF should be introduced urgently; the most cost-effective method of doing so would be targeting all people aged over 65 by opportunistic screening by GPs via pulse checking, with ECGs (heart tracings) to be arranged for those with irregular pulses;
• The previous strategy of identifying patients with AF at high risk of stroke has shifted to identify those few people who are at low risk of stroke and do not require any preventive treatment.
• The use of anti-coagulant treatments must increase, with accompanying improved awareness for doctors and patients regarding the clearly established benefits and often over-estimated risks of side effects in order to negate outdated medical perceptions regarding the suitability and acceptability of such treatments to patients; and
• Aspirin has proven to be ineffective in preventing stroke in AF and should not be used as an

alternative to anticoagulants. Patients currently being prescribed aspirin for AF should be reviewed and offered anticoagulation or have aspirin withdrawn.

Dr Scott Ramsay, Royal College of Physicians of Edinburgh (RCPE) and Consultant in Stroke Medicine, said,

“Atrial fibrillation is often a silent condition with serious consequences in the form of stroke. Its symptoms can go undetected, there has been uncertainty amongst doctors regarding how to treat it effectively and a lack of medical and public awareness about sufferers’ significantly increased risk of developing a stroke. The goal of treating atrial fibrillation is primarily to reduce the current unacceptable levels of avoidable stroke and the disability and premature death it causes. This is an issue of national significance and we have reached consensus that the most effective way of doing this would be for national screening programmes to be introduced throughout the UK for all people over 65 as a matter of urgency.

“In addition, it is clear that the evidence has moved on and historic methods of stroke prevention in atrial fibrillation, such as prescribing aspirin instead of anticoagulants have proven to be ineffective but have significant side effects. For all patients in atrial fibrillation, except those few at truly low risk of stroke,  anticoagulation is the only effective stroke prevention and should be offered as treatment”.

Contact:               Graeme McAlister on 07733-263453 or 07808-93939

ENDS

[1] The RCPE UK Consensus Conference on Atrial Fibrillation was held at the RCPE in Edinburgh on 1 and 2 March 2012.

[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.