Atrial fibrillation and antithrombotic treatment in Italian hospitalized patients: a prospective, observational study

We studied the prevalence of atrial fibrillation within a large Italian inpatient population, and evaluated the use of antithrombotic therapy among these individuals.

A prospective cross sectional study (Phase 1) with a 1-year follow-up period (Phase 2) was conducted at a single Italian centre. During Phase 1, we conducted a chart review of all inpatients on 5 separate days, each 1 month apart, between January and May 1999. During Phase 2, at 1-year of follow-up, patients or their families were contacted to document the occurrence of new clinical events, as well as current antithrombotic therapy use.

A total of 3121 patient charts were reviewed. The prevalence of atrial fibrillation was 7.2%. Of these 224 patients, 21.3% were on oral anticoagulants, 29.7% on antiplatelets, while 49% received neither. Patients on oral anticoagulants were significantly younger (mean age 72.3 years) than those on antiplatelets (mean age 80.6 years; p<0.001) or neither therapy (mean age 80.7 years; p<0.001). At 1 year follow up, an acute ischaemic stroke occurred among 7.4% of the 121 contacted patients. Among patients with chronic atrial fibrillation [98], 25.5% were receiving an oral anticoagulant.

Despite clear evidence from clinical trials, oral anticoagulants are significantly underused among patients with chronic atrial fibrillation. Methods should be developed to improve both physician and patient knowledge about the overall benefits of anti-thrombotic therapy among these individuals.