[Quality of antithrombotic therapy in patients with chronic atrial fibrillation: the AFib Trial].
BACKGROUND
Large randomised studies have definitely shown that oral anticoagulation effectively reduces thromboembolic complications, e.g. stroke, in patients with chronic non-valvular atrial fibrillation (AFib). However, less than 50% of the eligible AFib patients receive anticoagulation, although their risk of thromboembolic disease is increased 5-7 fold as compared to individuals who have a regular sinus rhythm. This is the reason why undertreatment needs to be evaluated and addressed. In Germany, data on the antithrombotic therapy of these patients are sparse, national guidelines are lacking.


OBJECTIVE
This prospective cohort study is the first one to evaluate the quality of antithrombotic prevention in two groups of AFib outpatients in two different, socio-demographically comparable regions of Germany (Südbaden and Südwürttemberg) over a period of several years. Quality of care is defined as the percentage of AFib patients in a certain region treated according to international guidelines. If the percentage in both cohorts does not exceed 80%, guidelines are to be developed and implemented in Südwürttemberg on consideration of the specific treatment conditions in this region; their applicability is to be evaluated later.


METHODS
Office-based specialists of internal and general medicine are currently recruiting 200 AFib patients in each study region for documentation of their clinical data. Besides the quality of antithrombotic chemoprevention, relevant problems emerging in antithrombotic therapy in an ambulant setting will be identified. In the area of intervention (Südwürttemberg) experts and office-based physicians will exclusively develop evidence-based guidelines and disseminate them among doctors. Six months after the implementation of these guidelines in Südwürttemberg, their influence on prescribing patterns will be determined by comparing the proportion of anticoagulated AFib patients in Südwürttemberg to that of the control cohort (Südbaden). In addition, secondary outcomes of interest include deaths, days of hospitalisation, and incidence of stroke or bleeding episodes for different antithrombotic treatments.
Bücheler
Reinhild
R
Abteilung Klinische Pharmakologie, Institut für Pharmakologie und Toxikologie, Universitätsklinikum Tübingen.
Meisner
Christoph
C
Mörike
Klaus
K
Fux
Richard
R
Hauswald
Kirsten
K
Lorenz
Gernot
G
Kühlkamp
Volker
V
Gleiter
Christoph H
CH
D001281:Atrial Fibrillation / Q000188:drug therapy*; D002908:Chronic Disease; D015331:Cohort Studies; D005194:Family Practice / Q000592:standards; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005858:Germany; D006801:Humans; D010045:Outpatients; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D011446:Prospective Studies
D005343:Fibrinolytic Agents