Prognosis and guideline-adherent antithrombotic treatment in patients with atrial fibrillation and atrial flutter. Implications of undertreatment and overtreatment in real life clinical practice: The Loire Valley Atrial Fibrillation Project.
Chest. 2011 Mar 24;
Authors: Gorin L, Fauchier L, Nonin E, Charbonnier B, Babuty D, Lip GY
ABSTRACT BACKGROUND: In patients with atrial fibrillation (AF), adherence to guidelines for antithrombotic treatment is poorly followed and undertreatment (or 'non-adherence' with guidelines) is associated with a worse prognosis. Our objective was to evaluate if this was also the case in a large contemporary series of unselected AF patients in 'real world' clinical practice. METHODS: All patients with AF or atrial flutter seen in our institution between 2000 and 2007 were identified in a database and followed up for mortality and stroke. Antithrombotic guideline adherence was assessed according to the 2006 ACC/AHA/ESC guidelines. RESULTS: We reviewed outcomes in 3,646 consecutive patients with AF or atrial flutter (age 71±14 years; mean CHADS(2) score 1.5±1.1). Antithrombotic treatment was in agreement with the guidelines in 53% of patients, whereas 31% were classed as 'undertreated' and 16% as 'overtreated'. Among other parameters, non permanent AF/flutter was independently associated with an increased risk of undertreatment. After a follow-up of 953±767 days (median=771, interquartile range=1,286 days), guideline adherence was associated with a lower risk of adverse events (death from all causes or stroke) compared to undertreatment (Relative risk [RR] =0.47, 95%CI 0.40-0.55, p<0.0001). Overtreatment was associated with a lower risk of adverse events compared to the guideline adherent population (RR=0.40, 95%CI 0.28-0.58, p<0.0001). Factors independently associated with increased risk of mortality or stroke were antithrombotic undertreatment, older age, heart failure, renal failure, diabetes, male sex and previous history of stroke. CONCLUSIONS: Guideline non adherence or undertreatment with antithrombotic in unselected 'real world' patients with AF or atrial flutter is independently associated with a higher risk of stroke and mortality.
PMID: 21436246 [PubMed - as supplied by publisher]