title: A national survey of the management of atrial fibrillation with antithrombotic drugs in Italian primary care.
abstract: The aims of this study were to investigate trends in the incidence of diagnosed atrial fibrillation (AF), and to identify factors associated with the prescription of antithrombotics (ATs) and to identify the persistence of patients with oral anticoagulant (OAC) treatment in primary care. Data were obtained from 400 Italian primary care physicians providing information to the Health Search/Thales Database from 2001 to 2004. The age-standardised incidence of AF was: 3.9-3.0 cases, and 3.6-3.0 cases per 1,000 person-years in males and females, respectively. During the study period, 2,016 (37.2%) patients had no prescription, 1,663 (30.7%) were prescribed an antiplatelet (AP) agent, 1,440 (26.6%) were prescribed an OAC and 301 (5.5%) had both prescriptions. The date of diagnosis (p = 0.0001) affected the likelihood of receiving an OAC. AP, but not OAC, use significantly increased with a worsening stroke risk profile using the CHADS2 risk score. Older age increased the probability (p < 0.0001) of receiving an AP, but not an OAC. Approximately 42% and 24% of patients persisted with OAC treatment at one and two years, respectively, the remainder interrupted or discontinued their treatment. Underuse and discontinuation of OAC treatment is common in incident AF patients. Risk stratification only partially influences AT management.
authors.affiliation: Health Search, Italian College of General Practitioners, Florence, Italy. mazzaglia.giampiero@simg.it
authors.forename: Giampiero
authors.initials: G
authors.lastname: Mazzaglia
authors.forename: Alessandro
authors.initials: A
authors.lastname: Filippi
authors.forename: Marianna
authors.initials: M
authors.lastname: Alacqua
authors.forename: Warren
authors.initials: W
authors.lastname: Cowell
authors.forename: Annabelle
authors.initials: A
authors.lastname: Shakespeare
authors.forename: Lorenzo G
authors.initials: LG
authors.lastname: Mantovani
authors.forename: Cosetta
authors.initials: C
authors.lastname: Bianchi
authors.forename: Claudio
authors.initials: C
authors.lastname: Cricelli
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D015994:Incidence; D007558:Italy; D008297:Male; D054539:Medication Therapy Management; D008875:Middle Aged; D010349:Patient Compliance; D011320:Primary Health Care; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D005343:Fibrinolytic Agents