Abdallah Mashal1, Amos Katz, Pesach Shvartzman. 1. Department of Family Medicine, Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel. mashal@bgu.ac.il
Abstract
BACKGROUND: Atrial fibrillation (AF) is the most common arrhythmia in adults and is associated with increased mortality and morbidity. OBJECTIVES: To characterize patients diagnosed with AF in primary care clinics in southern Israel. METHODS: We conducted a cross-sectional study in 14 primary care clinics of the largest health insurance fund in Israel, reviewing the electronic medical records of adults aged > or = 25 years diagnosed with AF. The prevalence, evaluation, antithrombotic treatment and treatments for rate control/rhythm control were analyzed. RESULTS: We retrieved the records of 995 patients with a diagnosis of AF; the prevalence of AF was 1.5% (2.5% aged > or = 45 years). The patients' mean age was 73.5 +/- 1.4 years and 55.3% were female. Vitamin K antagonist (VKA) was prescribed for 591 patients (59%), of whom 8.5% had no international normalized ratio follow-up tests for at least 3 months before our review. Among patients in the VKA treatment group the risk for thromboembolic events was considered to be high, moderate and low in 22% (n=131), 66% (n=391) and 12% (n=69), respectively. Patients with a low Congestive Hypertension Age Diabetes Stroke (CHADS2) score (odds ratio = 0.555, 95% confidence interval 0.357-0.862) and patients who did not receive VKA (OR = 0.601, 95% CI 0.459-0.787) received significantly less rate-control treatment. Of the patients with a low CHADS2 score (< 1) 52.7% received VKA treatment, and 39.4% with a high CHADS2 score (> or = 3) did not receive VKA. A positive correlation was found between anticoagulation and rate or rhythm control. CONCLUSIONS: The prevalence and age distribution of AF in southern Israel are similar to findings in the western world. Many of the patients did not receive appropriate antithrombotic prophylaxis.
BACKGROUND:Atrial fibrillation (AF) is the most common arrhythmia in adults and is associated with increased mortality and morbidity. OBJECTIVES: To characterize patients diagnosed with AF in primary care clinics in southern Israel. METHODS: We conducted a cross-sectional study in 14 primary care clinics of the largest health insurance fund in Israel, reviewing the electronic medical records of adults aged > or = 25 years diagnosed with AF. The prevalence, evaluation, antithrombotic treatment and treatments for rate control/rhythm control were analyzed. RESULTS: We retrieved the records of 995 patients with a diagnosis of AF; the prevalence of AF was 1.5% (2.5% aged > or = 45 years). The patients' mean age was 73.5 +/- 1.4 years and 55.3% were female. Vitamin K antagonist (VKA) was prescribed for 591 patients (59%), of whom 8.5% had no international normalized ratio follow-up tests for at least 3 months before our review. Among patients in the VKA treatment group the risk for thromboembolic events was considered to be high, moderate and low in 22% (n=131), 66% (n=391) and 12% (n=69), respectively. Patients with a low Congestive Hypertension Age Diabetes Stroke (CHADS2) score (odds ratio = 0.555, 95% confidence interval 0.357-0.862) and patients who did not receive VKA (OR = 0.601, 95% CI 0.459-0.787) received significantly less rate-control treatment. Of the patients with a low CHADS2 score (< 1) 52.7% received VKA treatment, and 39.4% with a high CHADS2 score (> or = 3) did not receive VKA. A positive correlation was found between anticoagulation and rate or rhythm control. CONCLUSIONS: The prevalence and age distribution of AF in southern Israel are similar to findings in the western world. Many of the patients did not receive appropriate antithrombotic prophylaxis.