title: Discrepancy between guidelines for stroke prevention in atrial fibrillation and practice patterns in primary care. The nationwide French AFIGP survey.
abstract: BACKGROUND
  General practitioners (GPs) play a pivotal role in the long-term management of patients with atrial fibrillation (AF), including anticoagulant prophylaxis for stroke prevention.
  
  
  OBJECTIVE
  To investigate the antithrombotic prescription behaviours of GPs in France and compare them with the European Society of Cardiology (ESC) guidelines for stroke prevention, and to identify the major determinants of use of antithrombotic therapy.
  
  
  METHODS
  We conducted a cross-sectional survey, using data from the French Longitudinal Patient Database, on the use of antithrombotic treatments for stroke prevention in 15,623 patients (≥18years of age) with AF who attended at least one GP consultation between July 2010 and June 2011. Data were collected on patient baseline characteristics, stroke risk factors, and prescription of antithrombotic drugs.
  
  
  RESULTS
  The mean age was 74.6±11.1years, 59.5% were men, and 83.1% had a CHADS2 score≥1. Over half (52.6%) of the patients with a CHADS2 score≥1 received a vitamin K antagonist (alone or in combination with an antiplatelet), 19.3% received aspirin alone, and 23.4% received no antithrombotic therapy; 3.6% of the patients received dual antiplatelet therapy and 1.1% clopidogrel alone. Over half of the patients (56.3%) were treated in accordance with the ESC 2010 guidelines. Of the remaining patients, 19.4% received no treatment, 13.0% were inadequately treated, and 11.2% were over-treated. Factors associated with antithrombotic treatment were anti-arrhythmic therapy, higher stroke risk, presence of atherothrombotic disease, and use of non-steroidal anti-inflammatory drugs. Female gender was associated with a lower likelihood of antithrombotic treatment.
  
  
  CONCLUSIONS
  In this large French study, approximately 45% of thromboembolic high-risk patients were either not treated or inadequately treated. Better compliance with evidence-based guidelines is needed to reduce the burden of stroke in the AF population.
authors.affiliation: Heart Institute, Department of Cardiology, Pitié-Salpétrière Hospital, Pierre-and-Marie-Curie University, 75013 Paris, France. Electronic address: pierre.sabouret@psl.aphp.fr.
authors.forename: Pierre
authors.initials: P
authors.lastname: Sabouret
authors.affiliation: Bristol-Myers Squibb, 92500 Rueil-Malmaison, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Bricard
authors.affiliation: Bristol-Myers Squibb, 92500 Rueil-Malmaison, France.
authors.forename: Marie-Annick
authors.initials: MA
authors.lastname: Hermann
authors.affiliation: Bristol-Myers Squibb, 92500 Rueil-Malmaison, France.
authors.forename: Francois-Emery
authors.initials: FE
authors.lastname: Cotté
authors.affiliation: Bristol-Myers Squibb, 92500 Rueil-Malmaison, France.
authors.forename: Leyla
authors.initials: L
authors.lastname: Deret-Bixio
authors.affiliation: Thrombosis Research Institute, SW3 6LR London, UK.
authors.forename: Sophie
authors.initials: S
authors.lastname: Rushton-Smith
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D002309:Cardiology / Q000639:trends*; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D011307:Drug Prescriptions; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005602:France; D058005:General Practitioners / Q000639:trends; D019983:Guideline Adherence / Q000639:trends*; D019538:Health Care Surveys; D054625:Healthcare Disparities / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000639:trends*; D011314:Preventive Health Services / Q000639:trends*; D011320:Primary Health Care / Q000639:trends*; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D020521:Stroke / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents
keywords: Anticoagulants; Antithrombotics; Atrial fibrillation; Fibrillation atriale; General practitioners; Guidelines; Médecins généralistes; Recommandations