Results from the Registry of Atrial Fibrillation (AFABE): Gap between Undiagnosed and Registered Atrial Fibrillation in Adults--Ineffectiveness of Oral Anticoagulation Treatment with VKA.

Anna Panisello-Tafalla,Vicente F Gil-Guillen,María Lluisa Queralt-Tomas,Iñigo Lechuga-Duran,Rosa Ripolles-Vicente,Jesús Carot-Domenech,Jorgina Lucas-Noll,Miquel Gallofré López,Josep Lluís Clua-Espuny,Antonia González-Henares,Carlos López-Pablo

doi:10.1155/2015/134756

Abstract

Objective. This study aimed to examine the effectiveness of the use of oral anticoagulation (OAC) medication, recommended by national guidelines for stroke prevention but reportedly underused in AF patients with moderate to high stroke risk. Method. A multicentre and cross-sectional study of undiagnosed AF among out-of-hospital patients over 60 years old was carried out, visiting 3,638 patients at primary health centres or at home for AF diagnosis using the IDC-10 classification. The main outcome measures were CHA2DS2VASC, HAS-BLED scores, cardiovascular comorbidity, pharmacological information, TTR, and SAMe-TT2R2 scores. Results. The main findings were undiagnosed AF in 26.44% of cases; 31.04% registered with AF but not using OAC despite 95.6% having a CHA2DS2VASC ≥ 2 score; a risk of bleeding in important subgroups using OAC without indication (37.50% CHA2DS2VASC < 2 score); the use of OAC with TTR < 60% (33.1%), of whom 47.6% had a HAS-BLED score ≥3. Thus, 35.4% of the expected AF prevalence achieved an optimal time in the therapeutic range. Conclusions. The expected AF prevalence was 10.9% (n 5267), but the registered prevalence was 7.5% (n 3638). Only 35.04% (CI = 95%, 33.7–36.3) of AF patients treated with vitamin K antagonists (VKAs) achieve the goal of TTR > 60%.

Highlights

Atrial fibrillation (AF) is a common cardiac arrhythmia [1] that affects 1-2% of the general population and accounts for one-third of hospitalizations for heart rhythm disturbances
We described clinical comorbidities included in the cardioembolic CHA2DS2VASC rule [14, 15] and HAS-BLED [16, 17] codistribution representing bleeding risk among AF patients treated with vitamin K antagonists (VKAs)
Patients with a CHA2DS2VASC score ≥ 2 were categorized as high stroke risk and those with a HASBLED score ≥ 3 were categorized as high bleeding risk

Summary

Introduction

Atrial fibrillation (AF) is a common cardiac arrhythmia [1] that affects 1-2% of the general population and accounts for one-third of hospitalizations for heart rhythm disturbances. With the aging of the population, the number of patients with AF is expected to increase 150% in the four decades, with more than 50% of patients being over the age of 80 This increasing burden from AF will lead to a higher incidence of stroke, as patients with AF have a five- to sevenfold greater risk of stroke than the general population [3, 4]. The costs of managing AF patients and its complications have been well documented and are high [5] This will have serious implications for the planning of health and welfare systems, because of predictions of a continuous increase in AF prevalence [3, 6, 7] given the close association between arrhythmia and aging, and because of the current cost constraints due to the economic context

Methods

Results

Discussion

Conclusion