Jesús Díez-Manglano1, Javier Gomes-Martín2, Patricia Al-Cheikh-Felices2, Soledad Isasi de Isasmendi Pérez2, Raquel Díez-Angulo2, Carolina Clemente-Sarasa2. 1. Internal Medicine Department, Hospital RoyoVillanova, Zaragoza, Spain; Research Group on Comorbidity and Polypathology in Aragón, Aragón Health Sciences Institute, Zaragoza, Spain; Department of Medicine, Dermatology and Psychiatry, University of Zaragoza School of Medicine, Spain. Electronic address: jdiez@aragon.es. 2. Internal Medicine Department, Hospital RoyoVillanova, Zaragoza, Spain.
Abstract
OBJECTIVE: Determining the adherence to ACC/AHA/ESC 2006 guidelines and its influence on the survival of patients with atrial fibrillation. METHODS: Prospective observational study of patients discharged during 2007 from an Internal Medicine department with a main or secondary diagnose of atrial fibrillation. The stroke risk was estimated with the CHADS2 score. The follow-up was carried out in outpatient medical office or via telephone. RESULTS: We included 259 patients (mean age 80.9 years); 73% of them had a high risk of stroke. Oral anticoagulants were administered to 134 (51.7%), and antiplatelet drugs to 71 (27%) patients. A rate control strategy was chosen for 155 (59.8%) patients and a rhythm control one for 28 (10.8%). In 100 (38.6%) patients, treatment was adherent to the guidelines. Adherence to the guidelines was associated with age (0.95 95%CI 0.92-0.99; p=0.03), contraindication to the use of oral anticoagulants (0.38 95%CI 0.18-0.81; p=0.01) and mitral valve heart disease/valvular prosthesis (2.10 95%CI 1.04-4.25; p=0.04). The median follow-up was 727 days, and 191 patients died. Patients treated according to the guidelines had a higher rate of survival during the first three years (0.47 vs. 0.36; p=0.049). The use of oral anticoagulants was associated with a higher probability of survival over a 5 year period (0.34 vs 0.21; p=0.001) and the rate control strategy during the first year (0.69 vs 0.57; p=0.04). CONCLUSIONS: In the real world, the treatment of atrial fibrillation according to the guidelines is associated with improved survival for up to three years during follow-up.
OBJECTIVE: Determining the adherence to ACC/AHA/ESC 2006 guidelines and its influence on the survival of patients with atrial fibrillation. METHODS: Prospective observational study of patients discharged during 2007 from an Internal Medicine department with a main or secondary diagnose of atrial fibrillation. The stroke risk was estimated with the CHADS2 score. The follow-up was carried out in outpatient medical office or via telephone. RESULTS: We included 259 patients (mean age 80.9 years); 73% of them had a high risk of stroke. Oral anticoagulants were administered to 134 (51.7%), and antiplatelet drugs to 71 (27%) patients. A rate control strategy was chosen for 155 (59.8%) patients and a rhythm control one for 28 (10.8%). In 100 (38.6%) patients, treatment was adherent to the guidelines. Adherence to the guidelines was associated with age (0.95 95%CI 0.92-0.99; p=0.03), contraindication to the use of oral anticoagulants (0.38 95%CI 0.18-0.81; p=0.01) and mitral valve heart disease/valvular prosthesis (2.10 95%CI 1.04-4.25; p=0.04). The median follow-up was 727 days, and 191 patients died. Patients treated according to the guidelines had a higher rate of survival during the first three years (0.47 vs. 0.36; p=0.049). The use of oral anticoagulants was associated with a higher probability of survival over a 5 year period (0.34 vs 0.21; p=0.001) and the rate control strategy during the first year (0.69 vs 0.57; p=0.04). CONCLUSIONS: In the real world, the treatment of atrial fibrillation according to the guidelines is associated with improved survival for up to three years during follow-up.
Authors: Christian Fastner; Michael Behnes; Benjamin Sartorius; Mustafa Yildiz; Kambis Mashayekhi; Ibrahim El-Battrawy; Ralf Lehmann; Stefan Baumann; Tobias Becher; Martin Borggrefe; Ibrahim Akin Journal: BMC Cardiovasc Disord Date: 2016-01-28 Impact factor: 2.298