The treatment of paroxysmal atrial fibrillation in UK primary care

The proportion of patients with a CHADS2 score of ≥1 prescribed anticoagulants increased between 2000 and 2015. Although improved, use in those with paroxysmal AF remains lower in 2015 (56.2% versus 69.4% in patients with persistent/permanent AF, RR 0.76; 95% CI 0.74 to 0.77).

The NICE clinical guideline states that the CHA2DS2-VASc stroke risk score should be used to assess stroke risk in people with any of the following:

• symptomatic or asymptomatic paroxysmal, persistent or permanent atrial fibrillation

• atrial flutter

• a continuing risk of arrhythmia recurrence after cardioversion back to sinus rhythm

Anticoagulation (apixaban, dabigatran etexilate, rivaroxaban or a vitamin K antagonist) should be offered to people with a CHA2DS2-VASc score of 2 or above, and also considered for men with a CHA2DS2-VASc score of 1 (taking bleeding risk into account).