[Treatment of atrial fibrillation at different levels of health care].
OBJECTIVE
Atrial fibrillation is managed in multiple settings by different specialists. We sought to analyze treatment and compliance of the prevailing guidelines of patients with atrial fibrillation attended at different levels of health care and to quantify interventions to correct treatment inadequacies.


METHODS
We included all adult patients with atrial fibrillation who presented during a 14 day-period to different levels of health care of a tertiary hospital and a related primary care clinic (family physician, cardiologist, emergency department, hospitalization). In all of them, clinical and epidemiological data in relation to atrial fibrillation, and all data referring to treatment and compliance of guidelines, were recorded prospectively.


RESULTS
293 patients were included. Clinical and epidemiological data were similar in the different settings. A great diversity in atrial fibrillation treatment was observed. In 30 and 33% of the patients, antiarrhythmic and antithrombotic treatment, respectively, did not meet the recommendations of the prevailing guidelines. The adequacy was inferior in primary care. The adequacy percentages increased slightly after the medical attention (2 and 3% respectively, p non significant) with no differences in this increase between the different settings.


CONCLUSIONS
There are no epidemiological differences between patients with atrial fibrillation treated at different levels of health care. An important number of patients do not follow the recommendations of the prevailing guidelines. There is a clear medical abstention in incorrectly treated cases.
Coll-Vinent
Blanca
B
Servicio de Urgencias, Hospital Clínic, Barcelona, España. bcvinent@clinic.ub.es
Junyent
Mireia
M
Orús
Josefina
J
Villarroel
Cristina
C
Casademont
Jordi
J
Miró
Oscar
O
Magriñà
Josep
J
Obach
Víctor
V
Sánchez
Miquel
M
Sitges
Marta
M
Bragulat
Ernest
E
Jiménez
Sònia
S
Pacheco
Gustavo
G
Brugada
Josep
J
Mont
Lluís
L
D000368:Aged; D001281:Atrial Fibrillation / Q000188:drug therapy*; D003695:Delivery of Health Care; D005260:Female; D006801:Humans; D008297:Male