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Is incentivising stroke prevention therapy in atrial fibrillation the key?


Atrial fibrillation (AF) is a condition of global importance with significant and progressive effects on morbidity, mortality and healthcare expenditure.1 The prevalence of AF is rising, and it is projected to at least double over the next 30 years due to advancing age and increasing risk factors for developing AF including cardiovascular illness and adverse lifestyle factors. AF is the leading cause of stroke, and by comparison to other types of stroke,2 AF-related stroke is more severe; yet highly preventable. Although we have overwhelming evidence that oral anticoagulation (OAC) is highly effective in preventing stroke in patients with AF,3 therapy has remained underused until recently.

In their Heart paper, Adderley et al4 report the results of temporal trends in age-sex standardised AF prevalence and use of stroke prevention therapy among 744 primary care practices across the UK from 2000 to 2016. Once again, this demonstrates…

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