Current presentation and management of 7148 patients with atrial fibrillation in cardiology and internal medicine hospital centers: The ATA AF study

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• 作者：Giuseppe Di Pasquale ; Giovanni Mathieu ; Aldo Pietro Maggioni ; Gianna Fabbri ; Donata Lucci ; Giorgio Vescovo ; Salvatore Pirelli ; Francesco Chiarella ; Marino Scherillo ; Michele Massimo Gulizia ; Gualberto Gussoni ; Fabrizio Colombo ; Domenico Panuccio ; Carlo Nozzoli ; Massimo Zoni Berisso ; on behalf of ATA-AF Investigators
• 关键词：Atrial fibrillation ; Guidelines ; Anticoagulation ; Rhythm control ; Rate control
• 刊名：International Journal of Cardiology
• 出版年：2013
• 出版时间：10 September, 2013
• 年：2013
• 卷：167
• 期：6
• 页码：2895-2903
• 全文大小：793 K

文摘

Background

Atrial fibrillation (AF) is associated with a high risk of stroke and mortality.

Aims

To describe the difference in AF management of patients (pts) referred to Cardiology (CARD) or Internal Medicine (MED) units in Italy.

Methods and results

From May to July 2010, 360 centers enrolled 7148 pts (54 % in CARD and 46 % in MED). Median age was 77 years (IQR 70-83). Hypertension was the most prevalent associated condition, followed by hypercholesterolemia (28.9 % ), heart failure (27.7 % ) and diabetes (24.3 % ). MED pts were older, more frequently females and more often with comorbidities than CARD pts.

In the 4845 pts with nonvalvular AF, a CHADS₂ score ¡Ý 2 was present in 53.0 % of CARD vs 75.3 % of MED pts (p < .0001). Oral anticoagulants (OAC) were prescribed in 64.2 % of CARD vs 46.3 % of MED pts (p < .0001); OAC prescription rate was 49.6 % in CHADS₂ 0 and 56.2 % in CHADS₂ score ¡Ý 2 pts. At the adjusted analysis patients managed in MED had a significantly lower probability to be treated with OAC.

Rate control strategy was pursued in 51.4 % of the pts (60.5 % in MED and 43.6 % in CARD) while rhythm control was the choice in 39.8 % of CARD vs 12.9 % of MED pts (p < .0001).

Conclusions

Cardiologists and internists seem to manage pts with large epidemiological differences. Both CARD and MED specialists currently fail to prescribe OAC in accordance with stroke risk. Patients managed by MED specialists have a lower probability to receive an OAC treatment, irrespective of the severity of clinical conditions.