title: Association between atrial fibrillation, anticoagulation, risk of cerebrovascular events and multimorbidity in general practice: a registry-based study.
abstract: BACKGROUND
  To date, there has been no comprehensive study on the association between atrial fibrillation (AF) and multimorbidity. The present study investigated the epidemiology of AF and the association between multimorbidity and the onset of AF. In addition, the correlation between multimorbidity and the use of anticoagulants and the risk of cerebrovascular events considering multimorbidity was explored in AF patients.
  
  
  METHODS
  Intego is a primary care registry network in Belgium. A case-control study was performed using Intego data from a 10-year time interval (2002 to 2011). All patients aged 60 years and older in 2002 who had developed new AF between 2002 and 2011 were selected, as well as a group of matched control patients. In addition, the prescription of anticoagulants and incident cerebrovascular events were recorded in patients with AF.
  
  
  RESULTS
  AF showed a prevalence of 5.3 % in 2002, and an upward trend was observed between 2002 and 2011. In all, 1830 patients with AF and 6622 control patients were included. AF patients had significantly more comorbidities (mCCI (modified Charlson Comorbidity Index) 5 ± 2 vs 4 ± 2, P < 0.001). In addition, 9.7 % of patients with AF developed a cerebrovascular event (mean follow-up time of 2.7 ± 2.5 years). Both the under- and overuse of anticoagulants was observed. Of the 49 % of patients with AF who were considered at high risk (CHADS2 ≥ 2), 50 % received anticoagulants in the first six months after diagnosis, whereas 49 % of patients who were at low risk (CHADS2 = 0) did not.
  
  
  CONCLUSIONS
  AF is highly prevalent in older primary care patients and is significantly associated with multimorbidity. A discrepancy between the guidelines and clinical practice of anticoagulant use was observed. As multimorbidity seems to play a role in this, further qualitative research to study the perception and motives of the general practitioner is needed.
authors.affiliation: Department of General Practice, KU Leuven (KUL), Kapucijnenvoer 33, blok j bus 7001, 3000, Leuven, Belgium. vigdis.vanbeselaere@gmail.com.
authors.forename: Vigdis
authors.initials: V
authors.lastname: Vanbeselaere
authors.affiliation: Department of General Practice, KU Leuven (KUL), Kapucijnenvoer 33, blok j bus 7001, 3000, Leuven, Belgium.
authors.forename: Carla
authors.initials: C
authors.lastname: Truyers
authors.affiliation: Department of General Practice, KU Leuven (KUL), Kapucijnenvoer 33, blok j bus 7001, 3000, Leuven, Belgium.
authors.forename: Steven
authors.initials: S
authors.lastname: Elli
authors.affiliation: Department of General Practice, KU Leuven (KUL), Kapucijnenvoer 33, blok j bus 7001, 3000, Leuven, Belgium.|Department of General Practice, Maastricht University (UM), Maastricht, The Netherlands.
authors.forename: Frank
authors.initials: F
authors.lastname: Buntinx
authors.affiliation: Department of General Practice, KU Leuven (KUL), Kapucijnenvoer 33, blok j bus 7001, 3000, Leuven, Belgium.
authors.forename: Harrie
authors.initials: H
authors.lastname: De Witte
authors.affiliation: Department of General Practice, KU Leuven (KUL), Kapucijnenvoer 33, blok j bus 7001, 3000, Leuven, Belgium.|Institute of Health and Society, Université Catholique de Louvain (UCL), Brussels, Belgium.
authors.forename: Jan
authors.initials: J
authors.lastname: Degryse
authors.affiliation: Department of General Practice, KU Leuven (KUL), Kapucijnenvoer 33, blok j bus 7001, 3000, Leuven, Belgium.|Institute of Health and Society, Université Catholique de Louvain (UCL), Brussels, Belgium.
authors.forename: Séverine
authors.initials: S
authors.lastname: Henrard
authors.affiliation: Department of General Practice, KU Leuven (KUL), Kapucijnenvoer 33, blok j bus 7001, 3000, Leuven, Belgium.|Institute of Health and Society, Université Catholique de Louvain (UCL), Brussels, Belgium.
authors.forename: Bert
authors.initials: B
authors.lastname: Vaes
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D001530:Belgium / Q000453:epidemiology; D015897:Comorbidity; D005260:Female; D058006:General Practice / Q000592:standards; D019983:Guideline Adherence; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D015995:Prevalence; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants
keywords: Aged; Anticoagulation; Atrial fibrillation; Cerebrovascular event; Multimorbidity