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Published on: February 28, 2012
[Characteristics of oral anti-coagulation treatment in high-risk chronic auricular fibrillation]
J L Clua Espuny1, M R Dalmau Llorca, C Aguilar Martín
1Tortosa 1 Est, Tortosa, Tarragona, Spain. jlclua.tarte.ics@gencat.net
Insights
40% of chronic auricular fibrillation (CAF) cases are high-risk. Many patients with high-risk CAF received oral anticoagulation treatment (OAT) only after a vascular complication, indicating delayed diagnosis and treatment.
Area of Science:
- Cardiology
- Public Health
Context:
- Chronic auricular fibrillation (CAF) is a significant cardiovascular condition.
- Understanding the prevalence and management of high-risk CAF (CAFhr) is crucial for patient outcomes.
Purpose:
- To determine the prevalence of CAF and CAFhr.
- To assess the coverage and timing of oral anticoagulation treatment (OAT) in high-risk patients.
- To analyze the relationship between CAF diagnosis, vascular complications, and OAT initiation.
Summary:
- A multi-center study found CAF prevalence at 2.2%, with 40% classified as high-risk.
- Oral anticoagulation treatment (OAT) covered 74.2% of high-risk patients, but 41.7% experienced vascular complications concurrently with CAF diagnosis.
- INR monitoring showed similar results in primary care and hospital settings.
Impact:
- Highlights a substantial proportion of high-risk CAF patients.
- Reveals delays in OAT initiation, often occurring after vascular events.
- Suggests opportunities for earlier detection and intervention to improve thromboembolism prevention.
Objective:
To calculate the prevalence of chronic auricular fibrillation (CAF), how much of it is considered high-risk (CAFhr) and the degree of coverage with oral anti-coagulation treatment (OAT).
Design:
Multi-centre descriptive study.
Setting:
9 health districts. The "Terres de l'Ebre" Primary Care Service.
Participants:
Randomised sample of 375 patients with CAF, of whom 150 met the criteria of CAFh-r during 2002.
Main Measurements:
Profile of patients with CAFh-r; coverage with OAT; place of follow-up; presence of vascular complications, and the time relationships between the diagnosis of CAF, vascular complications and the start of OAT. All the INR determinations taken from the patients included in the study were used.
Results:
There was 2.2% prevalence of CAF (95% CI, 1.4-3.3). 40% of CAF had criteria of CAFh-r. 74.2% were treated with OAT. In 41.7% the diagnosis of CAF coincided with the incidence of some vascular complication. There were no differences between the overall results of the INR obtained in hospital and in PC. The expected efficacy of OAT for thromboembolism prevention in our high-risk sample was 61.12%.
Conclusions:
40% of the CAF are high-risk. In over a third of patients OAT was indicated after a vascular complication linked to an unknown CAF. The INR between 2-3 is similar in PC centres and the corresponding haematology service.
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