Doctors advised against aspirin for patients with irregular heart rhythm

Aspirin’s effectiveness for those with atrial fibrillation is now questioned, says Nice in new guidance, which also notes the raised bleeding risk. Photograph: Tim Boyle/Getty

Aspirin should no longer be used to try to prevent strokes in people with a common heart rhythm disorder as it is ineffective and has acted as a “smokescreen”, preventing people from getting the right treatment, government experts say.

The advice, published on Wednesday, affects 100,000 people with atrial fibrillation, which causes the heart to beat irregularly and sometimes too fast, and who are taking aspirin. They have been advised by the National Institute for Health and Care Excellence (Nice) to see their GP to discuss alternative medication.

The experts say the majority of people with atrial fibrillation, which is believed to affect more than a million people in Britain – about a quarter of them undiagnosed – and is a condition that increases the risk of stroke fivefold, should be given anticoagulants. This overrides previous advice, issued in 2006, which approved antiplatelets such as aspirin.

Campbell Cowan, chair of the group that drew up the health guidance, said: “Aspirin has been a little bit of a smokescreen to anticoagulation. We now know that aspirin is not safer and it is questionable whether it has any effect at all, so aspirin is no longer recommended for stroke prevention.”

Nice said that strokes among people with atrial fibrillation were “highly preventable” and 7,000 a year could be averted if treated with anticoagulants, as well as 2,000 premature deaths.

The now superseded 2006 guideline on atrial fibrillation was the only one in which Nice recommended use of aspirin in primary prevention. It still recommends the drug for management of patients with a combination of heart failure and coronary heart disease and those who have suffered a transient ischaemic attack, or mini-stroke.

Only half of those who should be on anticoagulants are getting them at present, according to the experts. “Any stroke occurring in a patient with atrial fibrillation is a tragedy because it was preventable,” said Cowan.

Because of the risk of bleeding, the guidance group does not recommend anticoagulants for people at low risk of stroke or with a high risk of bleeding, both of which can be calculated using new tools published by Nice. Cowan said that only about 6% of people with atrial fibrillation would not get anticoagulants under the new guidelines. The risk of bleeding is believed to be one reason why many GPs have favoured aspirin, which has been given to people with atrial fibrillation for 20 years, but the guidance group found that aspirin carried an increased chance of bleeding.

Despite the findings, Cowan warned patients against any knee-jerk reaction as they might have been given aspirin for another reason, such as coronary heart disease. “They need to continue on aspirin,” he said. “They can’t assume they are taking aspirin for their atrial fibrillation so they should consult with the doctor.”

The low uptake of anticoagulants in the past has also been attributed to the fact that the most common variety, warfarin, requires regular monitoring and dose adjustments to ensure it works properly, making it unsuitable for elderly patients who have mobility problems or are housebound.

The Nice experts recommend increased uptake of a new generation of oral anticoagulants, which are more expensive than warfarin but require less regular monitoring and dose adjustments.

The experts say that the drugs should be made available not just to those at risk not currently on anticoagulants but to those on warfarin who have poor monitoring, estimated to be a third of the total taking the drug.

Stephen Whitehead, chief executive of the Association of the British Pharmaceutical Industry, welcomed Nice’s guidance but said Britain was lagging behind Europe when it came to uptake of new oral anticoagulants. He called on clinicians to “ensure that they do not prevent patients, who would benefit from these medicines, having access to them”.

Doctors advised against aspirin for patients with irregular heart rhythm

Doctors advised against aspirin for patients with irregular heart rhythm

Aspirin’s effectiveness for those with atrial fibrillation is now questioned, says Nice in new guidance, which also notes the raised bleeding risk. Photograph: Tim Boyle/Getty

Aspirin should no longer be used to try to prevent strokes in people with a common heart rhythm disorder as it is ineffective and has acted as a “smokescreen”, preventing people from getting the right treatment, government experts say.

The advice, published on Wednesday, affects 100,000 people with atrial fibrillation, which causes the heart to beat irregularly and sometimes too fast, and who are taking aspirin. They have been advised by the National Institute for Health and Care Excellence (Nice) to see their GP to discuss alternative medication.

The experts say the majority of people with atrial fibrillation, which is believed to affect more than a million people in Britain – about a quarter of them undiagnosed – and is a condition that increases the risk of stroke fivefold, should be given anticoagulants. This overrides previous advice, issued in 2006, which approved antiplatelets such as aspirin.

Campbell Cowan, chair of the group that drew up the health guidance, said: “Aspirin has been a little bit of a smokescreen to anticoagulation. We now know that aspirin is not safer and it is questionable whether it has any effect at all, so aspirin is no longer recommended for stroke prevention.”

Nice said that strokes among people with atrial fibrillation were “highly preventable” and 7,000 a year could be averted if treated with anticoagulants, as well as 2,000 premature deaths.

The now superseded 2006 guideline on atrial fibrillation was the only one in which Nice recommended use of aspirin in primary prevention. It still recommends the drug for management of patients with a combination of heart failure and coronary heart disease and those who have suffered a transient ischaemic attack, or mini-stroke.

Only half of those who should be on anticoagulants are getting them at present, according to the experts. “Any stroke occurring in a patient with atrial fibrillation is a tragedy because it was preventable,” said Cowan.

Because of the risk of bleeding, the guidance group does not recommend anticoagulants for people at low risk of stroke or with a high risk of bleeding, both of which can be calculated using new tools published by Nice. Cowan said that only about 6% of people with atrial fibrillation would not get anticoagulants under the new guidelines. The risk of bleeding is believed to be one reason why many GPs have favoured aspirin, which has been given to people with atrial fibrillation for 20 years, but the guidance group found that aspirin carried an increased chance of bleeding.

Despite the findings, Cowan warned patients against any knee-jerk reaction as they might have been given aspirin for another reason, such as coronary heart disease. “They need to continue on aspirin,” he said. “They can’t assume they are taking aspirin for their atrial fibrillation so they should consult with the doctor.”

The low uptake of anticoagulants in the past has also been attributed to the fact that the most common variety, warfarin, requires regular monitoring and dose adjustments to ensure it works properly, making it unsuitable for elderly patients who have mobility problems or are housebound.

The Nice experts recommend increased uptake of a new generation of oral anticoagulants, which are more expensive than warfarin but require less regular monitoring and dose adjustments.

The experts say that the drugs should be made available not just to those at risk not currently on anticoagulants but to those on warfarin who have poor monitoring, estimated to be a third of the total taking the drug.

Stephen Whitehead, chief executive of the Association of the British Pharmaceutical Industry, welcomed Nice’s guidance but said Britain was lagging behind Europe when it came to uptake of new oral anticoagulants. He called on clinicians to “ensure that they do not prevent patients, who would benefit from these medicines, having access to them”.

Doctors advised against aspirin for patients with irregular heart rhythm

Air pollution linked to irregular heart beat, review finds

Quick-term exposure to air pollution could improve a person’s threat of irregular heart beat or blood clots in the lung, a new study has advised.

But researchers identified “no clear proof” for results of quick-phrase pollution on a certain type of heart attack or stroke.

The authors from the London School of Hygiene and Tropical Medication wished to examine the biological affect of quick-term air pollution on cardiovascular occasions.

They utilised information from 3 databases across England and Wales about heart attacks, hospital admissions and deaths for the time period 2003 to 2009 and in contrast them to pollution occasions recorded by the Uk Air Quality Info Archive.

The research, published in the journal Heart, looked at some 400,000 heart attacks, much more than two million emergency admissions for cardiovascular troubles and 600,000 deaths from cardiovascular disease.

These were linked to regular amounts of air pollutants in excess of a time period of five days from the monitoring station nearest to the area of residence.

They measured various sorts of air pollutants like carbon monoxide, nitrogen dioxide, particulate matter much less than 10 micrometres in aerodynamic diameter (PM10), particulate matter much less than two.five micrometres in aerodynamic diameter (PM2.five), sulphur dioxide, and ozone.

No clear link with any air pollutant was discovered for cardiovascular deaths, with the exception of PM2.5 which was linked to an enhanced threat of irregular heart rhythms, irregular heart beat and blood clots in the lungs.

Only nitrogen dioxide was linked to an increased threat of a hospital admission for cardiovascular difficulties, like heart failure, and an elevated threat of a particular sort of heart assault.

Earlier this yr, it estimated that outdoor air pollution was responsible for the deaths of 3.7 million individuals globally in the course of 2012.

And English overall health officials recently known as on nearby authorities to do much more to defend men and women from air pollution.

Prolonged-term exposure to air pollution led to about 25,000 deaths in England in 2010, Public Health England (PHE) stated.

PHE stated that air top quality had improved “considerably” in the Uk more than current decades due to new, cleaner engineering and tighter environmental legislation.
But it mentioned neighborhood action could be taken to decrease emissions of these man-manufactured particles and people’s exposure to air pollution.

Air pollution linked to irregular heart beat, review finds