Website intended for a NZ health professional readership
The risk–benefit assessment for anticoagulation in atrial fibrillation in the elderly is a conundrum, but considering the relative consequences of stroke, which might be greater than those of anticoagulant-related bleeds, can be of help in decision-making
1. Odutayo A, Wong CX, Hsiao AJ et al. Atrial fibrillation and risks of cardiovascular disease, renal disease, and death: systematic review and meta-analysis. BMJ 2016;354:i4482.
2. Fitzmaurice DA, Hobbs FDR, Jowett S et al. Screening versus routine practice in detection of atrial fibrillation in patients aged 65 or over: cluster randomised controlled trial. BMJ 2007;335:383.
3. BPAC. Management of atrial fibrillation in general practice. Best Pract J 2011. BPJ: 39. Available online at https://bpac.org.nz/bpj/2011/october/af.aspx
4. Teh R, Kerse N, Kepa M et al. Self-rated health, health-related behaviours and medical conditions of Maori and non-Maori in advanced age: LiLACS NZ. NZ Med J 2014;127(1397):13–29.
5. BPAC. The use of antithrombotic medicines in general practice: a consensus statement. Best Pract J 2011. BPJ: 39. Available online at https://bpac.org.nz/bpj/2011/october/antithrombotic.aspx
6. Turagam MK, Velagapudi P, Flaker GC. Stroke prevention in the elderly atrial fibrillation patient with comorbid conditions: focus on non-vitamin K antagonist oral anticoagulants Clin Interv Aging 2015;10:1431–44.
Pharmacist prescribers Linda Bryant and Leanne Te Karu discuss positive polypharmacy for heart failure. Current evidence shows the intensive implementation of four medications offers the greatest benefit to most patients with heart failure, with significant reductions in cardiovascular mortality, heart failure hospitalisations and all-cause mortality
