title: European Primary Care Cardiovascular Society (EPCCS) consensus guidance on stroke prevention in atrial fibrillation (SPAF) in primary care.
abstract: BACKGROUND
  Atrial fibrillation affects 1-2% of the general population and 10% of those over 75, and is responsible for around a quarter of all strokes. These strokes are largely preventable by the use of anticoagulation therapy, although many eligible patients are not treated. Recent large clinical trials have added to the evidence base on stroke prevention and international clinical guidelines have been updated.
  
  
  METHODS
  Consensus practical recommendations from primary care physicians with an interest in vascular disease and vascular specialists.
  
  
  METHODS
  A focussed all-day meeting, with presentation of summary evidence under each section of this guidance and review of European guidelines on stroke prevention in atrial fibrillation, was used to generate a draft document, which then underwent three cycles of revision and debate before all panel members agreed with the consensus statements.
  
  
  RESULTS
  Six areas were identified that included how to identify patients with atrial fibrillation, how to determine their stroke risk and whether to recommend modification of this risk, and what management options are available, with practical recommendations on maximising benefit and minimising risk if anticoagulation is recommended and the reasons why antiplatelet therapy is no longer recommended. The summary evidence is presented for each area and simple summary recommendations are highlighted, with areas of remaining uncertainty listed.
  
  
  CONCLUSIONS
  Atrial fibrillation-related stroke is a major public health priority for most health systems. This practical guidance can assist generalist community physicians to translate the large evidence base for this cause of preventable stroke and implement this at a local level.
authors.affiliation: Nuffield Department of Primary Care Health Sciences, University of Oxford, UK richard.hobbs@phc.ox.ac.uk.
authors.forename: Fd Richard
authors.initials: FR
authors.lastname: Hobbs
authors.affiliation: Department of Primary Care Clinical Sciences, University of Birmingham, UK.
authors.forename: Clare J
authors.initials: CJ
authors.lastname: Taylor
authors.affiliation: Julius Center for Health Sciences and Primary Care, University of Utrecht, the Netherlands.
authors.forename: Geert
authors.initials: G
authors.lastname: Jan Geersing
authors.affiliation: Julius Center for Health Sciences and Primary Care, University of Utrecht, the Netherlands.
authors.forename: Frans H
authors.initials: FH
authors.lastname: Rutten
authors.affiliation: Medcon International, Heemstede, the Netherlands.
authors.forename: Judith R
authors.initials: JR
authors.lastname: Brouwer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D002309:Cardiology / Q000592:standards*; D032921:Consensus; D005060:Europe; D019317:Evidence-Based Medicine; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011320:Primary Health Care / Q000592:standards*; D011322:Primary Prevention / Q000592:standards*; D018570:Risk Assessment; D012307:Risk Factors; D012955:Societies, Medical / Q000592:standards*; D020521:Stroke / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants
keywords: Atrial fibrillation; anticoagulation; bleeding risk; stroke prevention; stroke risk