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Prevalence and antithrombotic management of atrial fibrillation in hospitalised patients
  1. Dana Berti1,
  2. Eline Moors2,
  3. Philip Moons2,3,4,
  4. Hein Heidbuchel5
  1. 1Department of Cardiovascular Medicine, KU Leuven—University of Leuven, University Hospitals Leuven, Leuven, Belgium
  2. 2Department of Public Health and Primary Care, KU Leuven—University of Leuven, Centre for Health Services and Nursing Research, Leuven, Belgium
  3. 3Copenhagen University Hospital, The Heart Centre, Copenhagen, Denmark
  4. 4University of Gothenburg, Institute of Health and Care Sciences, Sweden
  5. 5Hasselt University and Heart Center Hasselt, Jessa Hospital, Hasselt, Belgium
  1. Correspondence to Dana Berti, Cardiology—Electrophysiology, University Hospitals Leuven, Herestraat 49, Leuven B-3000, Belgium; Dana.Berti{at}uzleuven.be

Abstract

Objectives The objective of this study was to determine the prevalence of atrial fibrillation (AF) in a tertiary care centre, to describe the comorbidity profile of hospitalised patients with AF, and to evaluate the appropriateness of their maintenance antithrombotic management.

Methods In a cross-sectional, descriptive study, all consenting hospitalised patients from 36 wards in a University hospital (excluding critical care units, psychiatric, maternity and paediatric wards) received an ECG on a single day. Also their charts were reviewed for key demographic and clinical data. For patients with AF, all factors and comorbidities comprising thromboembolic (CHA2DS2-VASc) and bleeding risk (HAS-BLED) were listed. The appropriateness of long-term anticoagulant therapy was assessed according to the 2010 international guidelines (CHA2DS2-VASc score 0=aspirin or no antithrombotic treatment; 1=aspirin or oral anticoagulant treatment (OAC); ≥2=OAC). The response rate was 79.7%, that is, an ECG was performed in 636 of 812 eligible hospitalised patients.

Results AF was present on ECG in 58 patients reflecting a 9.1% hospital point prevalence (95% CI 6.9% to 11.3%). Of the remaining 587 participants, 49 had a history of AF. Hence, 107 AF cases were identified, yielding a total prevalence of 16.8% (95% CI 13.9% to 19.7%). Patients with AF were detected in every hospital zone, with highest prevalence rates in zone ‘thorax’ (29.3% (95% CI 22.2% to 36.4%)) and ‘internal medicine’ (21.7% (95%CI 14.8% to 28.6%)). Patients with AF were older than patients without AF (78.7±10.3 years versus 62.7±15.9 years; p<0.001). The most common associated comorbidities were hypertension (63.6%) and valvular heart disease (58.9%). Most patients with AF were at high risk for stroke (CHA2DS2-VASc-score ≥2 in 92.5%). Overall, only 51.3% of all patients did receive appropriate anticoagulant long-term management, while 31% were undertreated and 17.7% were possibly overtreated.

Conclusions This hospital-based study revealed high AF prevalence rates (16.8%). Patients with AF were present in all hospital zones and almost all patients were at high risk for stroke. Anticoagulation management was likely inappropriate in 48.7%, indicating the need for better guideline implementation initiatives to guarantee hospital-wide optimised care for patients with AF.

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