Birmingham, UK—Patients diagnosed with atrial fibrillation are usually treated with anticoagulants and beta blockers. But what should happen to drug therapy when the heart goes back to its normal rhythm?

A study published recently in The BMJ looks at that question and whether medications should be discontinued when the condition appears resolved.

University of Birmingham–led researchers found that patients whose heart rhythm appears to return to normal continue to be at high risk of stroke and should continue to be treated.

To come to that conclusion, the study team examined patient records from 640 general practices throughout the UK and compared the frequency of strokes in three groups of people: those with ongoing atrial fibrillation; those whose records said that atrial fibrillation had resolved; and those who never had atrial fibrillation.

“What we found was that strokes were least common in people who never had atrial fibrillation, and much more common in people whose records said their atrial fibrillation had been resolved,” explained lead author Nicola Adderly, PhD, MPH, of the University of Birmingham’s Institute of Applied Health Research. “Significantly, in recent years we found that strokes were nearly as common in people whose atrial fibrillation had resolved as in those with ongoing atrial fibrillation. Therefore, we can conclude that people with resolved atrial fibrillation continue to be at high risk of stroke.”

Researchers expressed concerned that patients whose medical records said their condition had been resolved were no longer receiving medications for atrial fibrillation. “Our research demonstrates that although people with resolved atrial fibrillation continue to be at high risk of stroke, they are not getting their prevention drugs,” said coauthor Krish Nirantharakumar, MD. “Worryingly, we found that the problem seems to be becoming more common, with our research showing an increasing number of people are recorded as having atrial fibrillation as resolved and are highly unlikely to be given medication to prevent stroke.”

Results indicate that adjusted incidence-rate ratios for stroke or transient ischemic attack (TIA) in patients with resolved atrial fibrillation were 0.76 (95% confidence interval 0.67 to 0.85, P <0.001) as compared with controls with atrial fibrillation, and 1.63 (1.46 to 1.83, P <0.001) versus controls without atrial fibrillation.

For patients with “resolved” atrial fibrillation, adjusted incidence-rate ratios were 0.60 (0.56 to 0.65, P <0.001) versus controls with atrial fibrillation and 1.13 (1.06 to 1.21, P <0.001) versus controls without atrial fibrillation. When patients with resolved atrial fibrillation and documented recurrent atrial fibrillation were excluded, however, the adjusted incidence rate ratio for stroke or TIA was 1.45 (1.26 to 1.67, P <0.001) versus controls without atrial fibrillation.

The researchers point out that, in 2016, one in 10 patients with atrial fibrillation—around 160,000 people in the UK—were classified as having had their condition resolved. Coauthor Tom Marshall, PhD, suggested that the condition probably hadn’t gone away, however, “Atrial fibrillation can be present one day and absent the next, so giving someone the all-clear may be a mistake. Another possibility is that it can come back. Many people don’t know when they have this condition and it can come back without them or their doctor realizing.”

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