A Filippi1, G Bettoncelli, A Zaninelli. 1. Family Physician, S.I.M.G. (Italian Society of General Practice), via. S. Francesco 14, 24050 Mozzanica, Italy.
Abstract
BACKGROUND: Atrial fibrillation (AF) is a major risk factor in the development of ischaemic stroke. The rate of embolic events can be reduced significantly by appropriate therapy. Epidemiological data and information about the attitude of physicians towards prophylaxis of thromboembolism are crucial to determine future strategies to decrease strokes in patients with AF. Unfortunately, these data are unknown in Italy. OBJECTIVES: The aims of this study were to study the prevalence of diagnosed AF in northern Italy, to estimate the percentage of high, moderate and low risk patients and to investigate the pattern of embolic prophylaxis among GPs. METHODS: Fifty-one GPs reviewed all the clinical records of subjects aged >/=40 years and identified those patients with chronic or paroxysmal AF. RESULTS: Among 41 050 patients, 719 [1.75%; 95% confidence interval (CI) 1.59-1.91] had AF (70% chronic, 30% paroxysmal). Only 4% were at low risk for ischaemic stroke, whereas 32% were at moderate and 64% at high risk. Contraindications to antiplatelet or anticoagulant therapy were present in 11% of AF patients. Antithrombotic prophylaxis was underused among the 51 GPs. CONCLUSIONS: Detection of AF could be 30-40% lower than real prevalence and, therefore, adequate evaluation and treatment aimed at avoiding ischaemic stroke could be denied to a great number of Italian patients. AF detection and prophylaxis of thromboembolic risk can be improved among GPs in northern Italy.
BACKGROUND:Atrial fibrillation (AF) is a major risk factor in the development of ischaemic stroke. The rate of embolic events can be reduced significantly by appropriate therapy. Epidemiological data and information about the attitude of physicians towards prophylaxis of thromboembolism are crucial to determine future strategies to decrease strokes in patients with AF. Unfortunately, these data are unknown in Italy. OBJECTIVES: The aims of this study were to study the prevalence of diagnosed AF in northern Italy, to estimate the percentage of high, moderate and low risk patients and to investigate the pattern of embolic prophylaxis among GPs. METHODS: Fifty-one GPs reviewed all the clinical records of subjects aged >/=40 years and identified those patients with chronic or paroxysmal AF. RESULTS: Among 41 050 patients, 719 [1.75%; 95% confidence interval (CI) 1.59-1.91] had AF (70% chronic, 30% paroxysmal). Only 4% were at low risk for ischaemic stroke, whereas 32% were at moderate and 64% at high risk. Contraindications to antiplatelet or anticoagulant therapy were present in 11% of AFpatients. Antithrombotic prophylaxis was underused among the 51 GPs. CONCLUSIONS: Detection of AF could be 30-40% lower than real prevalence and, therefore, adequate evaluation and treatment aimed at avoiding ischaemic stroke could be denied to a great number of Italian patients. AF detection and prophylaxis of thromboembolic risk can be improved among GPs in northern Italy.