A new device that allows GPs and practice nurses to detect pulse irregularities and pick up cases of atrial fibrillation whilst measuring blood pressure has been recommended by NICE. Atrial fibrillation (AF) causes the heart to beat with an irregular rhythm. It can be difficult to detect and subsequently diagnose as it is often asymptomatic and can be intermittent.
People with AF are at increased risk of developing blood clots and subsequent stroke, with 423,000 people aged 65 and over expected to have AF, of whom some will be will living with the condition yet are undiagnosed.
In its medical technology guidance on WatchBP Home A, NICE says the device reliably detects AF and may increase the rate of detection when used in primary care. This will consequently allow for preventative treatment to be given and to reduce the incidence of AF-related stroke.
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Rivaroxaban for the prevention of stroke and systemic embolism in people with atrial fibrillation. (Full Guidance (PDF))
Technology appraisals, TA256 – Issued: May 2012
NICE recommends rivaroxaban as a possible treatment to prevent stroke and systemic embolism in some people with atrial fibrillation (see below).
Who can have rivaroxaban?
You should be able to have rivaroxaban if you have atrial fibrillation without underlying heart valve disease and at least one of the following applies:
- you have congestive heart failure (when the heart doesn’t pump blood as well as it should)
- you have high blood pressure
- you are 75 or older
- you have diabetes
- you have had a stroke or transient ischaemic attack (mini stroke) in the past.
via Atrial fibrillation (stroke prevention) – rivaroxaban.
The latest evidence
Map of Medicine monitors over 150 guidance producers, and constantly searches over 3,000 sources for the latest meta-analyses and systematic reviews, enabling healthcare professionals to stay abreast of changes through a single resource. Over 40 care maps have been updated with the very latest evidence in our current issue, including:
Acute coronary syndrome: two new pieces of guidance from NICE incorporated. Ticagrelor added as a treatment option for selected patients. Management of hyperglycaemia, including testing, provision of information and lifestyle advice added for people with poor glycaemic control.
Atrial fibrillation: new restrictions and monitoring requirements for the use of dronedarone in patients with atrial fibrillation, following MHRA Drug Safety Update.
Caesarean section: newly updated NICE recommendations including information on indications for caesarean section, including maternal request; and provision of evidence-based information and support for women.
Contraception: newly updated recommendations from the Faculty of Sexual and Reproductive Health (FSRH) on emergency contraception and combined hormonal contraception.
- Athens users: visit the Map here and select ‘International’ / ‘England’ or your local view
An NHS Athens account may be required in some cases:
Added in February
- Dehydration in hospital-admitted stroke patients: detection, frequency and association, Stroke, December 2011
- Increased short-term risk of thrombo-embolism or death after interruption of warfarin treatment in patients with atrial fibrillation, European Heart Journal, December 2011
- Interventions for treating anxiety after stroke, Cochrane Database of Systematic Reviews, December 2011
- Is tongxinluo more effective than isosorbide dinitrate in treating angina pectoris? A systematic review and meta-analysis of randomized controlled trials, Journal of Alternative and Complementary Medicine, December 2011
- Low-molecular-weight heparin and mortality in acutely ill medical patients, New England Journal of Medicine, December 2011
- Patient education in the management of coronary heart disease, Cochrane Database of Systematic Reviews, December 2011
- Rehabilitation after myocardial infarction trial (RAMIT): multi-centre randomised controlled trial of comprehensive cardiac rehabilitation in patients following acute myocardial infarction, Heart, December 2011
- Self-monitoring of oral anticoagulation: systematic review and meta-analysis of individual patient data, Lancet, January 2012
Added in January