title: Diagnosis and management of atrial fibrillation by primary care physicians in Italy : a retrospective, observational analysis.
abstract: BACKGROUND
  Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with a heavy burden of morbidity and mortality, mainly due to an increased risk of cerebrovascular events and cardiac failure. Oral anticoagulant (OAC) treatment prevents stroke and systemic thromboembolism in patients with AF and its use is strongly recommended in guidelines. However, its use in this patient group remains limited. Primary care physicians (PCPs) have an important role to play in this context.
  
  
  OBJECTIVE
  The primary objective was to estimate prevalence and epidemiological features of AF in the primary care setting, focusing on ischaemic and bleeding risk assessment. A secondary objective was to examine the PCPs' level of adherence to the guidelines for the prevention of thromboembolic risk in these patients.
  
  
  METHODS
  This retrospective, observational study was based on data entered by 128 PCPs into the Health Search (HS) Thales database, identifying patients with a diagnosis of AF at the time of the analysis.
  
  
  RESULTS
  Out of 167,056 patients analysed, 2,173 (1.3 %) were diagnosed with AF, with 86 % at high risk for ischaemic stroke, according to CHA(2)DS(2)-VASc (congestive heart failure, hypertension, age ≥75 years [doubled], diabetes, stroke [doubled], vascular disease, age 65-74 years, sex category [female]) stratification. After the diagnosis of AF, 84 % of patients were prescribed OAC treatment. However, at 2 years' follow-up, only 29.6 % were still being treated with OACs.
  
  
  CONCLUSIONS
  The prevalence of AF in this analysis was consistent with previously reported Italian national epidemiological data. Adherence to the European Society of Cardiology AF guidelines by PCPs was low, despite the high levels of stroke risk. At the end of the observation period less than one-third of patients were still on OAC therapy. Awareness of the benefits of OACs in stroke prevention in AF patients needs to be improved.
authors.affiliation: Co.Me.Gen. Coop (Cooperativa Medicina Generale Napoli), Cooperative of Primary Care Physicians, Via Cintia Parco S. Paolo 45, 80126, Naples, Italy. gpiccino@tin.it
authors.forename: Gaetano
authors.initials: G
authors.lastname: Piccinocchi
authors.forename: Matteo
authors.initials: M
authors.lastname: Laringe
authors.forename: Bruno
authors.initials: B
authors.lastname: Guillaro
authors.forename: Giovanni
authors.initials: G
authors.lastname: Arpino
authors.forename: Roberto
authors.initials: R
authors.lastname: Piccinocchi
authors.forename: Gerardo
authors.initials: G
authors.lastname: Nigro
authors.forename: Paolo
authors.initials: P
authors.lastname: Calabrò
mesh_terms: D000284:Administration, Oral; D000367:Age Factors; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D016009:Chi-Square Distribution; D015897:Comorbidity; D004363:Drug Utilization; D005260:Female; D019983:Guideline Adherence; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards; D015995:Prevalence; D011320:Primary Health Care / Q000592:standards; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000517:prevention & control; D013923:Thromboembolism / Q000453:epidemiology / Q000517:prevention & control; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants