title: Adherence to guidelines and mortality in atrial fibrillation.
abstract: OBJECTIVE
  Determining the adherence to ACC/AHA/ESC 2006 guidelines and its influence on the survival of patients with atrial fibrillation.
  
  
  METHODS
  Prospective observational study of patients discharged during 2007 from an Internal Medicine department with a main or secondary diagnose of atrial fibrillation. The stroke risk was estimated with the CHADS2 score. The follow-up was carried out in outpatient medical office or via telephone.
  
  
  RESULTS
  We included 259 patients (mean age 80.9 years); 73% of them had a high risk of stroke. Oral anticoagulants were administered to 134 (51.7%), and antiplatelet drugs to 71 (27%) patients. A rate control strategy was chosen for 155 (59.8%) patients and a rhythm control one for 28 (10.8%). In 100 (38.6%) patients, treatment was adherent to the guidelines. Adherence to the guidelines was associated with age (0.95 95%CI 0.92-0.99; p=0.03), contraindication to the use of oral anticoagulants (0.38 95%CI 0.18-0.81; p=0.01) and mitral valve heart disease/valvular prosthesis (2.10 95%CI 1.04-4.25; p=0.04). The median follow-up was 727 days, and 191 patients died. Patients treated according to the guidelines had a higher rate of survival during the first three years (0.47 vs. 0.36; p=0.049). The use of oral anticoagulants was associated with a higher probability of survival over a 5 year period (0.34 vs 0.21; p=0.001) and the rate control strategy during the first year (0.69 vs 0.57; p=0.04).
  
  
  CONCLUSIONS
  In the real world, the treatment of atrial fibrillation according to the guidelines is associated with improved survival for up to three years during follow-up.
authors.affiliation: Internal Medicine Department, Hospital RoyoVillanova, Zaragoza, Spain; Research Group on Comorbidity and Polypathology in Aragón, Aragón Health Sciences Institute, Zaragoza, Spain; Department of Medicine, Dermatology and Psychiatry, University of Zaragoza School of Medicine, Spain. Electronic address: jdiez@aragon.es.
authors.forename: Jesús
authors.initials: J
authors.lastname: Díez-Manglano
authors.affiliation: Internal Medicine Department, Hospital RoyoVillanova, Zaragoza, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Gomes-Martín
authors.affiliation: Internal Medicine Department, Hospital RoyoVillanova, Zaragoza, Spain.
authors.forename: Patricia
authors.initials: P
authors.lastname: Al-Cheikh-Felices
authors.affiliation: Internal Medicine Department, Hospital RoyoVillanova, Zaragoza, Spain.
authors.forename: Soledad Isasi de Isasmendi
authors.initials: SI
authors.lastname: Pérez
authors.affiliation: Internal Medicine Department, Hospital RoyoVillanova, Zaragoza, Spain.
authors.forename: Raquel
authors.initials: R
authors.lastname: Díez-Angulo
authors.affiliation: Internal Medicine Department, Hospital RoyoVillanova, Zaragoza, Spain.
authors.forename: Carolina
authors.initials: C
authors.lastname: Clemente-Sarasa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D017410:Practice Guidelines as Topic / Q000592:standards*; D011446:Prospective Studies
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors
keywords: Atrial fibrillation; Guidelines; Oral anticoagulants; Rate control; Rhythm control; Survival