Europace Advance Access published online on April 10, 2008
Europace, doi:10.1093/europace/eun086
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Atrial fibrillation management by practice cardiologists: a prospective survey on the adherence to guidelines in the real world
Cardiovascular Department, Hôpital de La Tour, Meyrin 1217, Geneva, Switzerland
Aims: The purpose of this prospective study was to characterize the clinical profile of patients with atrial fibrillation (AF) in cardiology practice and to assess how successfully guidelines have been implemented in real-world practice.
Methods and results: This prospective study involved 23 cardiologists established in office practice in Geneva. Enrolment started on 1 January 2005 and ended on 31 December 2005. Consecutive patients were included if they were >18 years and had AF documented on an ECG during the index office visit or during the preceding month. In this survey, 622 ambulatory patients were enrolled (390 males and 232 females; mean age 69.8 ± 11.8 years). The prevalence of paroxysmal, persistent, and permanent AF was 35, 18, and 47%, respectively. Underlying cardiac disorders present in 513 patients (82%) included hypertensive heart disease (30%), valvular heart disease (27%), coronary artery disease (18%), and myocardial disease (11%). A rate-control strategy was chosen in 53% of the patients (331/622). The mean CHADS2 score was 1.43 ± 1.24, and 458/622 patients (73.6%) had a CHADS2 score 
1. Among patients with an indication to oral anticoagulant therapy (OAT), 88% (403/458) effectively received it. The rate of OAT was closely correlated with an increasing CHADS2 score, particularly with patients age (72, 81, and 87% for patients <65, 65–75, and >75 years of age, respectively). True contraindication for OAT was present in 4% (18/458). In the low-risk group (CHADS2 score = 0), 58% were prescribed OAT, but in 37% of them only for a short period of time (cardioversion/ablation). After a follow-up of 396 ± 109 days, 72% of the study group (410/570) was still treated by OAT. During follow-up, 23/570 patients died (4%), essentially from a cardiovascular cause (15/23), 15 had a non-lethal embolic stroke (2.7%), and 8 had significant bleeding complications (1.5%).
Conclusion: This study shows one of the highest OAT prescription rates for AF reported until now and demonstrates how successfully guidelines can be applied in the real world. A definite overinterpretation of current guidelines is observed in low-risk patients with AF. True contraindication for OAT (4%) and significant bleeding during OAT (1.5%) were rare.
Key Words: Atrial fibrillation, Anticoagulants, Stroke, Guidelines
* Corresponding author. Tel: +41 22 782 97 78; fax: +41 22 785 18 63. E-mail address: zimmermann.family{at}bluewin.ch
Manuscript submitted 23 January 2008. Accepted after revision 18 March 2008.