Week 3
The story that I am looking at in the The Guardian this week is "GPs told not to use aspirin in heart rhythm cases".
This article is written by Haroon Siddique. As we know, aspirin has been used for 20 years, to prevent stroke in people with the heart rhythm disorder atrial fibrillation. The article starts off with the sentence, "Aspirin should no longer be used to try to prevent strokes in people with a common heart rhythm disorder as it is ineffective and has acted as a 'smokescreen', preventing people from getting the right treatment, government experts say." This topic has been deeply scientifically researched for some time now and I feel that this sentence is good for starting the article.
Siddique states that this news affects 100,000 people with atrial fibrillation. This causes the heart to beat irregularly and sometimes too fast. Before now, these people would have taken aspirin most days. He has backed up his statement with advice from "the National Institute for Heath and Care Excellence (Nice) to see their GP to discuss alternative medication."
Experts say that more than a million people in Britain, suffer from atrial fibrillation, about a quarter of them haven't been diagnosed. Siddique uses scientific evidence to write, "Nice said that strokes among people with atrial fibrillation were 'highly preventable' and 7,000 a year could be averted if treated with anticoagulants, as well as 2,000 premature deaths. Nice still recommend the drug for management of patients with a combination of heart failure and coronary heart disease and those who have suffered a transient ischemic attack, or mini-stroke."
Campbell Cowan, chair of the group that drew up the new health guidance, said, "Aspirin has been a little bit of a smokescreen to anticoagulants (medicines that prevent the blood from clotting as quickly or as effectively as normal) . We now know that aspirin is not safer and it is questionable whether it has any effect at all, as aspirin is no longer recommended for stroke prevention." According to the experts only half of those who should be on anticoagulants are getting them at present. Cowan went on to say, "Any stroke occurring in a patient with atrial fibrillation is a tragedy because it was preventable." The guidance group doesn't recommend anticoagulants for people at a low rick of stroke or high risk of bleeding. Cowan warned patients on aspirin not to simply stop taking it. "They can't assume they are taking aspirin for their atrial fibrillation so they should consult with the doctor."
The story that I am looking at in the Daily Mail this week is "Aspirin is 'wrong drug for 200,000 heart patients'".
Jenny Hope, Daily Mail's Medical Correspondent starts off the article with "More than 200,000 people being prescribed aspirin for a heart condition that can trigger a stroke should be swapped to more effective drugs as it doesn't work, say new NHS guidelines." I think that Hope's choice of starting sentence is more effective than Siddique's. Just by reading this sentence, can we achieve a higher, long lasting impact from this serious situation.
Hope has gone on to say that the NHS wants patients to use a new generation of anti-clotting agents or an estabolished drug called warfin, based on rat poison. Prescribing better drugs and treating more people at risk could save 7,000 strokes and 2,000 premature deaths.
It is though that a million Britons have atrial fibrillation (AF) which causes around one in seven strokes. That means that aproximately 14% of strokes are caused by AF. In AF, the upper chambers of the heart are out of rhythm and beat much faster than normal, which allows blood to pool and generate tiny blood clots which can trigger a stroke. Around half of patients who could benefit from anticoagulant drugs are not getting them, while others are prescribed aspirin.
New guidelines from the National Institute for Heath and Care Excellence (NICE) state that aspirin should no longer be prescribed to prevent AF-related strokes in people at low or moderate risk - a reversal from its 2006 guidance. These updated guidelines show that aspirin is not as effective as anticoagulants - and not as safe because it may be more likely to cause bleeding in both the brain and the stomach than other anti-clotting drugs.
Dr Campbell Cowan, chairman of NICE's guideline development group, said, "Aspirin has been a little bit of a smokescreen to anticoagulants. We now know that aspirin is not safer and it is questionable whether it has any effect at all, as aspirin is no longer recommended for stroke prevention. Any stroke occurring in a patient with atrial fibrillation is a tragedy because it was preventable." He said patients did not need to stop taking aspirin immediately - it might be prescribed for other medical reasons - but they should make a GP appointment to discuss their options.
In addition, those whose condition is poorly controlled with warfarin should be considered for newer drugs that do not need constant monitoring. The drugs dabigatran, rivaroxaban and apixaban have been approved as cost-efefctive for the NHS even though they can cost £64 a month compared with £1 for warfarin, plus regular clinic visits.
GPs feel under pressure not to prescribe them because of the expense. Many patients report tasking to be swapped because their warfarin treatment it not working, but are 'stonewalled'.
Hope has gone on to report from another expert's point of view, Dr Khalid Khan, who works at Wrexham Maelor Hospital, north Wales. Dr Khan is a consultant cardiologist, and said that the guidelines were 'defining a moment'. He said, "Currently there are many thousands of people with AF who unfortunately remain unprotected from the risk of stroke; whether they are on no treatment, on an ineffective treatment for AF such as aspirin, or on warfarin that is not being adequately controlled. 'Today's announcement gives doctors considerably more choice and clear guidance in this area'."
Both papers give a lot of scientific evidence to back their articles. With the Daily Mail providing a better roundup of perspectives.
Dr Campbell Cowan was quoted in both articles and provided a vital insight to the situation in question.