An ECG machine read out

New research has found that patients in the UK with the heart rhythm disorder atrial fibrillation could benefit from a novel prediction tool for assessing the risk of stroke and major bleeding.

The study published in the British Journal of General Practice tested the performance of the GARFIELD-AF tool in the UK population using primary care electronic records from more than 460,000 patients. The research project which was funded by the National Institute for Health and Care Research found that the tool had better scores for predicting strokes, major bleeding and death than existing tools used across the UK.

Dr Patricia Apenteng, Research Fellow at the Institute of Applied Health Research at the University of Birmingham and lead author of the paper said:

“Patients with atrial fibrillation have a five-fold increased risk of having a stroke, so effective management of the condition includes a good understanding of all levels of risk. Our findings attest to the potential of the GARFIELD-AF tool to support the management of atrial fibrillation, and there is a need for validation in routine care”.

The team led by researchers at the University of Birmingham and Warwick University tested the GARFIELD-AF tool that predicts the risk of stroke, bleeding and death in the UK population, and compared them with CHA2DS2VASc and HAS-BLED tools which are currently in use.

Patients with atrial fibrillation experience abnormal heart rhythms and can lead to increased risk of stroke and death. Anticoagulation therapy is often used in patients to reduce these risks, but it carries a risk of bleeding. The clinical management of atrial fibrillation involves assessing the risk of stroke and the risk of bleeding to determine if anticoagulation therapy would be beneficial in reducing the risk of stroke.

Dr Patricia Apenteng said:

“Adjusting the algorithm for use in UK clinical practice would optimise its performance in the UK population, and GARFIELD-AF can be embedded in primary care records to support decision-making around anticoagulation. This will ensure that those who need anticoagulation will receive it, and those who do not are not put at unnecessary risk of bleeding complications. The tool also allows the identification of patients with atrial fibrillation who are at risk of early mortality, enabling the initiation of integrated care to improve outcomes.”

Full citation:

Patricia N Apenteng, David Prieto-Merino, Siew Wan Hee, Trudie CA Lobban, Rishi Caleyachetty and David A Fitzmaurice. British Journal of General Practice 16 October 2023; BJGP.2023.0082. DOI: 10.3399/BJGP.2023.0082