Atrial Fibrillation: from the guidelines to the reality
Keywords:
Atrial Fibrillation, stroke prevention, anticoagulationAbstract
Background: Atrial Fibrillation (AF) is a very frequent arrhythmia. A
devastating consequence of AF is stroke and 15% of all strokes are
caused by AF. Several trials have proved a significant reduction in
the risk of stroke with anticoagulation (AC). New guidelines have
suggested AC for at least three weeks after cardioversion and
long term AC for patients older than 75 years with AF, as well as
those with risk factors for a thromboembolic event. Long-term
AC in the community is safe and effective, even in the elderly.
However, some physicians avoid prescribing AC.
Objectives: Determine the prevalence of AF in patients attending
the Internal Medicine Department of Fernando Fonseca Hospital,
over the last 9 years; study the prevalence of stroke in these
patients; determine the use of AC at discharge of patients with AF in 2004.
Design: retrospective, event driven clinical database analysis.
Results: In 9 years AF was found in 6.7% (927/13800) of
patients. In 2004, 122 patients with AF were hospitalised and
17.2% had cerebrovascular disease. AC on discharge was noted
in only 22.2% of these patients.
Conclusions: Even though it has been proved that AC reduces
the risk of stroke in patients with AF, in general practice the number
of patients anticoagulated is small. We must change this attitude
in order to reduce the morbility and mortality associated to stroke,
the leading cause of death in our country.
Downloads
References
Falk RH. Atrial Fibrillation. N Eng J Med 2001; 344:1067-1076.
Page RL. Newly Diagnosed Atrial Fibrillation. N Engl J Med 2004; 351:2408-2415.
Go AS, Hylek EM, Phillips KA, et al. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) study. JAMA 2001; 285:2370-2375.
Hart RG. Atrial Fibrillation and Stroke Prevention. N Engl J Med 2003; 349:1015-1016.
Cannegieter SC, Rosendaal FR, Wintzen AR et al. Optimal Oral anticoagulation Therapy in patients with mechanical heart valves. N Engl J Med 1995;333:11-17.
Ezekowitz MD, Falk RH. The Increasing Need for Anticoagulant Therapy to Prevent Stroke in Patients with Atrial Fibrillation. Mayo Clin Proc 2004; 79:904-013.
Peters NS, Schilling RJ, Kanagaratnam P et al. Atrial fibrillation: strategies to control, combat, and cure. Lancet 2002; 359:593-600.
Hart RG, Pearce LA, Rothbart RM et al. Stroke with intermittent atrial fibrillation: incidence and predictors during aspirin therapy. J AM Coll Cardiol 2000;35:183-187.
Yousef ZR, Tandy SC, Tudor V et al. Warfarin for non-reumatic atrial fibrillation: five year experience in a district general hospital. Heart 2004;
:1259-1262.
Hylek EM et al. Effect of Intensity of Oral Anticoagulation on Stroke Severity and Mortality in Atrial Fibrillation. N Engl J Med 2003; 349:1019-1025.
Fuster V, Ryden LE, Asinger RW et al. ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation: executive summary: a report of the American College of Cardiology / American Heart Association Task Force on practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to develop guidelines for the management of patients with Atrial Fibrillation): develop in collaboration with the North American Society of pacing and Electrophysiology. J Am Coll Card 2001;38:1231-1266.
Stevenson WG, Stevenson LW. Atrial Fibrillation and Heart Failure – Five More Years. N Engl J Med 2004; 351: 2437-2439.
Fang MC, Chang Y, Hylek EM et al. Advanced Age, Anticoagulation Intensity, and Risk for Intracranial Haemorrhage among Patients Taking Warfarin for Atrial Fibrillation. Ann Intern Med 2004; 141:745-751.
Cabral NL, Volpato D, Ogata TR et al. Fibrilação Atrial Crônica, AVC e Anticoagulação. Arq Neuropsiquiatr 2004; 62:1016-1021.
Árias EA, Navarro GM, Santos AA. Tratamiento anticoagulante oral en pacientes com fibrilación auricular no valvular. Aten primaria 2002; 30:284-289.
Fernandez IR, Valle RD, Francisco AG et al. Adecuación de la profilaxis tromboembólica en pacientes con fibrilación auricular crónica en 3 centros de atención primaria. Aten primaria 2004; 33:188-192.
Friberg J, Scharling H, Gadsb∅ll N et al. Comparison of the Impact of Atrial Fibrillation on the Risk of Stroke and Cardiovascular Death in Women versus Men (the Copenhagen City Heart Study). Am J Cardio 2004; 94:889-894.
Olsson SB. Stroke prevention with the oral direct thrombin inhibitor ximegalatran compared with warfarin in patients with non-valvular atrial fibrillation (SPORTIF III): randomised controlled trial. Lancet 2003;362:1691-1698.
Menéndez-Jándula B, Souto JC e Olivier A et al. Comparing Self-Management of Oral Anticoagulant Therapy with Clinic Management. Ann Intern Med 2005;142:1-10
Additional Files
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2023 Medicina Interna
Open Access
