title: [Treatment of atrial fibrillation at different levels of health care].
abstract: 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.
authors.affiliation: Servicio de Urgencias, Hospital Clínic, Barcelona, España. bcvinent@clinic.ub.es
authors.forename: Blanca
authors.initials: B
authors.lastname: Coll-Vinent
authors.forename: Mireia
authors.initials: M
authors.lastname: Junyent
authors.forename: Josefina
authors.initials: J
authors.lastname: Orús
authors.forename: Cristina
authors.initials: C
authors.lastname: Villarroel
authors.forename: Jordi
authors.initials: J
authors.lastname: Casademont
authors.forename: Oscar
authors.initials: O
authors.lastname: Miró
authors.forename: Josep
authors.initials: J
authors.lastname: Magriñà
authors.forename: Víctor
authors.initials: V
authors.lastname: Obach
authors.forename: Miquel
authors.initials: M
authors.lastname: Sánchez
authors.forename: Marta
authors.initials: M
authors.lastname: Sitges
authors.forename: Ernest
authors.initials: E
authors.lastname: Bragulat
authors.forename: Sònia
authors.initials: S
authors.lastname: Jiménez
authors.forename: Gustavo
authors.initials: G
authors.lastname: Pacheco
authors.forename: Josep
authors.initials: J
authors.lastname: Brugada
authors.forename: Lluís
authors.initials: L
authors.lastname: Mont
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000188:drug therapy*; D003695:Delivery of Health Care; D005260:Female; D006801:Humans; D008297:Male