The new Holy Grail

E was an 87 year old man with chronic bronchitis and some deafness. He presented yet again with increasing dyspnoea. I listened to his chest for the expected wheeze. “Haven't really got much better Doc, started the steroids like you said and doubled my inhalers.” Then I noted in the background the irregular, rapid pulse. I congratulated myself for my clinical acumen in spotting his atrial fibrillation.

For some time I had considered with unease the emerging evidence in favour of anticoagulation for older patients with atrial fibrillation. Audit within the practice showed only 60% of patients on any form of antithrombotic medication and most of these on aspirin.

I attend a typically didactic lecture from a group of teaching hospital cardiologists presenting the case for anticoagulation with impressive statistics and apparent scientific rigour. At the end …