Abstract

MOREIRA, Natalia; VAZQUEZ NOSIGLIA, Horacio; BURDIAT, Gerard  and  MUSACCO, Alejandra. Prevalence, presentation and antithrombotic management of atrial fibrillation in outpatient cardiology clinic. Rev.Urug.Cardiol. [online]. 2016, vol.31, n.1, pp.21-27. ISSN 0797-0048.

Background: atrial fibrillation (AF) is the most common sustained arrhythmia in clinical practice. There are few data in our country about the prevalence, presentation mode, thromboembolic risk profile and antithrombotic treatment of patients with AF in a cardiology outpatient clinic.  Methods: patients with AF were obtained by searching through the electronic medical records of 10 cardiologists outpatient visits throughout one whole month (June-July 2015). Demographic factors, thromboembolic risk score, type of AF, and use of antithrombotic drugs were reviewed. Qualitative variables were analyzed using Fisher’s exact test, and quantitative variables using Student’s t test or Mann-Whitney test, as appropriate.  Results: AF was recorded in 282 out of 1875 outpatient visits (15%), corresponding to 272 patients. The mean age of the patients with AF was 78.4+8.3 years, while it was 68.3+14 years in the non-AF patients (p <0.001). In males, 136 of 810 subjects had AF (16.7%); it was 136 of 1065 in females (12.7%) (p = 0.0171). The mean CHA₂DS₂-VASc score of non-valvular AF patients was 3.8 ± 1.4, while it was ³2 in 95.3%. Seventy percent of AF patients were found to have permanent/persistent AF, while the remainder 30% had paroxysmal AF. Permanent/persistent AF patients’ mean age was 79.2+7.9 years; it was 76.5+9 years in paroxysmal AF patients (p = 0.0207), while CHA₂DS₂VASc average score was 3.9+1.3 and 3.5+1.6 (p = 0.0099) respectively. Antithrombotic treatment was prescribed in 252 patients (92.6%), an oral anticoagulant (OAC) in 207 (76.1%), an antiplatelet in 55 (20.2%), and both in 10 (3.7%). OAC were prescribed in 171 of 191 (89.5%) patients with permanent/persistent AF, and in 36 of 81 (44.4%) (p < 0.0001) patients with paroxysmal AF. The prescribed OAC was warfarin in 64 patients (23.5%) and a direct anticoagulant (NOAC) in 143 (52.6%).  Conclusions: the prevalence of AF in cardiology outpatients visits was high and most often found in males. The mean age of patients with AF was 10 years higher than the rest of the population. In 95.3% of non-valvular AF patients the CHA₂DS₂VASc score was ³2 which made them eligible for OAC. The use of OAC was high, but it was more than doubled in permanent/persistent AF compared to paroxysmal AF, although the difference in mean age or risk score between the two groups was small. The use of NOAC exceeded warfarin by more than 2 to 1.

Keywords : ATRIAL FIBRILLATION; ANTITHROMBOTIC TREATMENT; AMBULATORY CARE.

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