Prevalence and antithrombotic management of atrial fibrillation in hospitalised patients

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 (CHA(2)DS(2)-VASc) and bleeding risk (HAS-BLED) were listed. The appropriateness of long-term anticoagulant therapy was assessed according to the 2010 international guidelines (CHA(2)DS(2)-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 (CHA(2)DS(2)-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.