Citation : Robert J Petrella, Luc Sauriol
Background : Information about current practice in primary care-based management of atrial fibrillation (AF) can help to improve care quality.
Purpose : To assess the epidemiology of AF and current patterns of treatment in order to identify therapeutic trends and aspects of current practice that may allow for care-gap identification.
Methods : We scrutinized the anonymized records of the South Western Ontario database (SWO) collected between July 2002 and October 2008 for information about the characteristics and management of AF patients.
Results : From a population of ~168,000 patients we identified 4922 patients with a diagnosis of AF (2.9%). The recorded prevalence of AF increased with age, from <2% at age <60 years to 6% in the age range 71–75 years and 10% at age ≥81 years. AF patients were characterized by an unfavourable cardiovascular risk profile including widespread hypertension (54% of all cases), coronary artery disease (37%) and heart failure (21%), many cases of which were advanced (New York Heart Association class III or IV). Diabetes (22%) and dyslipidaemia (31%) were also widely prevalent.
The most frequently prescribed anti-arrhythmic drugs (AADs) were sotolol (n=798), amiodarone (n=712) and propafenone (n=451). Recorded use of flecainide was relatively low (n=175). Rate control-agents were being prescribed for 1838 patients, beta-blockers for 1311 patients and calcium channel blockers (CCBs) for 784 patients.
Use of anticoagulants was higher among patients assigned to AADs than among those assigned to rate-control drugs (≥25% vs. ~10%). Overall prescription rates for other concomitant medications were >50% for ACE inhibitors/ARBs, 30–35% for statins and beta-blockers, and 27–29% for diuretics, digoxin and CCBs.
Conclusions : These Canadian patients with AF were relatively elderly and had multiple concomitant cardiovascular conditions and medications.
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