Misuse of antithrombotic therapy in atrial fibrillation patients: frequent, pervasive and persistent.
OBJECTIVE
To assess the use of antithrombotic therapy among atrial fibrillation (AF) patients in a Brazilian University Heart Hospital (InCor).


RESULTS
In a cross-sectional study we analyzed the charts of all patients treated at InCor in five separate days of 2002 (Phase 1). To assess the impact of admission to a cardiology hospital, a follow-up of the AF patients selected in Phase 1 was carried out after 1 year (Phase 2). The prevalence of AF in the 3,764 assessed charts was 8.0% (301 patients). In Phase 1, antiplatelets were prescribed to 21.2% and anticoagulant therapy (ACT) to 46.5% of AF patients; in Phase 2, to 19.9 and 57.8%, respectively. Thus, 32.2% (Phase 1) and 22.2% (Phase 2) of AF patients were not receiving any antithrombotic drug. Among AF patients with previous ischemic stroke (17.6%), only 49% (Phase 1) and 60.4% (Phase 2) were receiving ACT. As many as 34 and 22.6%, respectively, were not receiving any antithrombotic drug. After follow-up, a new acute embolic event was documented in 5.6% of patients, 17% died.


CONCLUSIONS
Anticoagulation is underused in AF patients and neither the fact of being treated by cardiologists in a University Hospital, nor the learning time-window of 1 year seemed to improve the antithrombotic care significantly.
Fornari
Luciana S
LS
Heart Institute, University of Sao Paulo Medical School, Sao Paulo, Brazil. luciana.fornari@uol.com.br
Calderaro
Daniela
D
Nassar
Ivana B
IB
Lauretti
Cristiane
C
Nakamura
Lidia
L
Bagnatori
Renato
R
Ageno
Walter
W
Caramelli
Bruno
B
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000401:mortality; D001938:Brazil / Q000453:epidemiology; D002300:Cardiac Care Facilities; D003430:Cross-Sectional Studies; D004617:Embolism / Q000517:prevention & control*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D019983:Guideline Adherence; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D013927:Thrombosis / Q000517:prevention & control*
D000925:Anticoagulants; D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors