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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Association between atrial fibrillation, anticoagulation, risk of cerebrovascular events and multimorbidity in
Vigdis Vanbeselaere1, Carla Truyers2, Steven Elli2
1Department of General Practice, KU Leuven (KUL), Kapucijnenvoer 33, blok j bus 7001, 3000, Leuven, Belgium. vigdis.vanbeselaere@gmail.com.
Insights
Atrial fibrillation (AF) is common in older adults and linked to multiple health conditions (multimorbidity). Clinical practice for anticoagulant use in AF patients often deviates from guidelines, especially in those with multimorbidity.
Area of Science:
- Cardiology
- Epidemiology
- Geriatric Medicine
Background:
- Atrial fibrillation (AF) prevalence and its association with multimorbidity lack comprehensive study.
- Investigating the link between multimorbidity and AF onset is crucial for understanding disease progression.
- Exploring anticoagulant use and cerebrovascular event risk in AF patients with multimorbidity is essential.
Purpose of the Study:
- To investigate the epidemiology of atrial fibrillation (AF) in older primary care patients.
- To examine the association between multimorbidity and the onset of AF.
- To explore anticoagulant use patterns and cerebrovascular event risk in AF patients with varying degrees of multimorbidity.
Main Methods:
- A 10-year case-control study (2002-2011) using the Belgian Intego primary care registry.
- Inclusion of patients aged 60+ who developed new-onset AF and matched controls.
- Recording of anticoagulant prescriptions and incident cerebrovascular events in AF patients.
Main Results:
- AF prevalence was 5.3% in 2002, showing an upward trend. AF patients exhibited significantly higher comorbidity scores (mCCI).
- 9.7% of AF patients experienced cerebrovascular events during a mean follow-up of 2.7 years.
- Discrepancies in anticoagulant use were noted: 50% of high-risk patients received treatment, while 49% of low-risk patients were undertreated.
Conclusions:
- Atrial fibrillation is highly prevalent in older primary care patients and strongly associated with multimorbidity.
- A significant gap exists between anticoagulant therapy guidelines and actual clinical practice in AF patients.
- Further qualitative research is warranted to understand general practitioners' perceptions and motivations regarding anticoagulant prescribing in multimorbid AF patients.
Background:
To date, there has been no comprehensive study on the association between atrial fibrillation (AF) and multimorbidity. The present study investigated the epidemiology of AF and the association between multimorbidity and the onset of AF. In addition, the correlation between multimorbidity and the use of anticoagulants and the risk of cerebrovascular events considering multimorbidity was explored in AF patients.
Methods:
Intego is a primary care registry network in Belgium. A case-control study was performed using Intego data from a 10-year time interval (2002 to 2011). All patients aged 60 years and older in 2002 who had developed new AF between 2002 and 2011 were selected, as well as a group of matched control patients. In addition, the prescription of anticoagulants and incident cerebrovascular events were recorded in patients with AF.
Results:
AF showed a prevalence of 5.3 % in 2002, and an upward trend was observed between 2002 and 2011. In all, 1830 patients with AF and 6622 control patients were included. AF patients had significantly more comorbidities (mCCI (modified Charlson Comorbidity Index) 5 ± 2 vs 4 ± 2, P < 0.001). In addition, 9.7 % of patients with AF developed a cerebrovascular event (mean follow-up time of 2.7 ± 2.5 years). Both the under- and overuse of anticoagulants was observed. Of the 49 % of patients with AF who were considered at high risk (CHADS2 ≥ 2), 50 % received anticoagulants in the first six months after diagnosis, whereas 49 % of patients who were at low risk (CHADS2 = 0) did not.
Conclusions:
AF is highly prevalent in older primary care patients and is significantly associated with multimorbidity. A discrepancy between the guidelines and clinical practice of anticoagulant use was observed. As multimorbidity seems to play a role in this, further qualitative research to study the perception and motives of the general practitioner is needed.
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