[Anticoagulatin in atrial fibrillation--status of therapy in a network of physicians].
Despite of sound evidence, that oral anticoagulation reduces substantially the incidence of stroke-events in patients with atrial fibrillation and concomitant risk factors, in daily practice only a part of these patients is in fact treated with anticoagulation. The aim of this cross-sectional study was to evaluate to which extent existing guidelines for the treatment of patients with atrial fibrillation are transformed in the "real world" context of a Swiss urban network of primary care providers. The greatest part (88.4%) of the included patients with atrial fibrillation had a high risk for thromboembolism and herewith the indication for anticoagulation was given. For a primary care collective the amount of patients with anticoagulation was high: 74.1% did receive this kind of preventive therapy. 89% had robust International normalized ratio (INR) values within the recommended range (INR 2.5-3.5). The most common reasons not to prescribe oral anticoagulation were: old age (17.5%; mostly in combination with other reasons), risk of falls (16.5%), medical indication not given (16.5%). Thus the recommendations of the guidelines have been transformed into practice for a bigger part of the included patients. Given these results a broadly implemented quality-improvement-project to bring up the anticoagulation rate even higher hardly seems to be efficacious and is presently not of top priority in this network of primary care providers.
Marty
T
T
Zmed (Zürcher Arztegemeinschaft AG) Zürich.
Hurni
R
R
Zoller
M
M
Steiger
U
U
Steurer
J
J
Eichler
K
K
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy*; D002908:Chronic Disease; D019091:Critical Pathways; D003430:Cross-Sectional Studies; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D020766:Intracranial Embolism / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D012306:Risk; D013557:Switzerland
D000925:Anticoagulants