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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.

journal_name

Int J Cardiol

journal_title

International journal of cardiology

authors

Díez-Manglano J,Gomes-Martín J,Al-Cheikh-Felices P,Pérez SI,Díez-Angulo R,Clemente-Sarasa C

doi

10.1016/j.ijcard.2014.07.098

subject

Has Abstract

pub_date

2014-09-20 00:00:00

pages

430-6

issue

2

eissn

0167-5273

issn

1874-1754

pii

S0167-5273(14)01308-4

journal_volume

176

pub_type

杂志文章

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