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.
Credits: Robert J Petrella, MD, PhD; Luc Sauriol, PhD