Stroke prophylaxis in patients with atrial fibrillation: What can we do about it? [6]

Friberg et al.1 have shown clearly, like others, that many patients with atrial fibrillation (AF) do not receive stroke prophylaxis. In their summary, they note that it is ‘urgent to increase awareness of the need for adequate stroke prophylaxis in AF patients’. I would like to highlight to the readers that there has been research conducted in Tasmania, Australia on an intervention which aimed to increase warfarin use in those at risk of stroke. Jackson et al.2 mailed guidelines, which were developed in consultation with local specialists, to 272 general practitioners and then approximately 60% of these were visited to discuss the guidelines. Jackson et al. showed that this form of ‘academic detailing’ was effective at increasing warfarin use in the intervention area compared with a control region (P < 0.001), which did not receive the guidelines and academic detailing. Furthermore, hospital admission data (in the intervention area) collected before and after the intervention showed a significant increase in the use of warfarin in patients at high risk of stroke (33 vs. 46% of eligible patients; P < 0.05).