Anticoagulation in "real world" patients with atrial fibrillation in Italy: results from the ISPAF (Indagine Sicoa Paziente Con Fibrillazione Atriale) survey study.
BACKGROUND
Atrial fibrillation (AF) is associated with a high risk of stroke and other thrombo-embolic events and their prevention relies on antithrombotic therapy, at present mainly with vitamin K antagonists (VKA). The aim of this study was to provide an overall picture on the extent to which current recommendations on oral anticoagulation (OAC) therapy with VKA in AF correspond to actually prescribed OAC in an unselected, real world, population of consecutive patients with AF in Italy. Secondary objective was to assess the rate of "optimal" anticoagulation.


METHODS
Sixty-three cardiology units located in different geographic areas of Italy enrolled a total of 2046 outpatients with nonvalvular AF (54% males and 46% females, age 73.3±10.2 years).


RESULTS
OAC with VKAs was prescribed in 1394 (68%) of patients and was progressively more frequent on going from paroxysmal (46%) to persistent (71%) and permanent AF (78%)(P<0.001). A high prescription rate (88%) occurred in patients with CHA2DS2-VASc >2. In patients with CHA2DS2-VASc=0 and HAS-BLED<3, still 59% were on OAC, whereas in 33% of patients with CHA2DS2-VASc ≥2 and HAS-BLED<3, OAC therapy was not prescribed. In patients with CHA2DS2-VASc ≥2 and HAS-BLED>3, the preference was towards OAC prescription. 66% of patients were at target for INR.


CONCLUSIONS
The ISPAF study shows that in an Italian population of real world patients with AF adherence to current guidelines on OAC therapy based on stroke-risk scoring system is rather high, although rate of prescription should be increased. However, contrary to recommendations, in a high proportion of low-risk patients OAC therapy is still prescribed, and this might expose patients to unjustified risks.
Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Pisana, Roma, Italy.
Maurizio
M
Volterrani
Ferdinando
F
Iellamo
Giuseppe
G
Rosano
Pasquale
P
Guarini
Enrico
E
Pusineri
Stefano
S
Bonassi
Claudio
C
Chimini
Fabio
F
Zaccà
Cesare
C
Proto
D000284:Administration, Oral; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D011159:Population Surveillance / Q000379:methods*; D017410:Practice Guidelines as Topic; D011379:Prognosis; D013923:Thromboembolism / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*
D000925:Anticoagulants
Anticoagulation; Atrial fibrillation; Guidelines; Survey; Thrombo-embolic risk; Vitamin K antagonist