Prognosis and Guideline-Adherent Antithrombotic Treatment in Patients With Atrial Fibrillation and Atrial Flutter
| Autor: | Villard, Eric, Perret, Claire, Gary, Françoise, Proust, Carole, Dilanian, Gilles, Hengstenberg, Christian, Ruppert, Volker, Arbustini, Eloisa, Wichter, Thomas, Germain, Marine, Dubourg, Olivier, Tavazzi, Luigi, Aumont, Marie-Claude, Degroote, Pascal, Fauchier, Laurent, Trochu, Jean-Noël, Gibelin, Pierre, Aupetit, Jean-François, Stark, Klaus, Erdmann, Jeanette, Hetzer, Roland, Roberts, Angharad, Barton, Paul J.R., Regitz-Zagrosek, Vera, Aslam, Uzma, Duboscq-Bidot, Laëtitia, Meyborg, Matthias, Maisch, Bernhard, Madeira, Hugo, Waldenström, Anders, Galve, Enrique, Cleland, John, Dorent, Richard, Roizes, Gerard, Zeller, Tanja, Blankenberg, Stefan, Goodall, Alison, Cook, Stuart, Tregouet, David, Tiret, Laurence, Isnard, Richard, Komajda, Michel, Charron, Philippe, Cambien, François, Gorin, Laurent, Nonin, Emilie, Charbonnier, Bernard, Babuty, Dominique, Lip, Gregory Y.H. |
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| Přispěvatelé: | Génomique cardiovasculaire, Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Génétique, pharmacologie et physiopathologie des maladies cardiovasculaires [CHU Pitié-Salpétriêre], Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases (ICAN), Université Pierre et Marie Curie - Paris 6 (UPMC)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Klinik und Poliklinik für Innere Medizin II, Universität Regensburg (UR), Philipps Universität Marburg = Philipps University of Marburg, IRCCS - Pavia, Universität Osnabrück - Osnabrück University, Service de cardiologie et maladies vasculaires [CHU Ambroise Paré], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Ambroise Paré [AP-HP], GVM Hospitals of Care and Research, Service de cardiologie, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), Département de la Médecine, Université Paris Diderot - Paris 7 (UPD7), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), CHU Trousseau [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Hôpital Pasteur [Nice] (CHU), Hôpital Saint Joseph Saint Luc, Cardiovascular Sciences, Medizinische Klinik II, Universität zu Lübeck = University of Lübeck [Lübeck], University of Liverpool, Aalborg University [Denmark] (AAU) |
| Rok vydání: | 2011 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty business.industry Atrial fibrillation Guideline Critical Care and Intensive Care Medicine Lower risk medicine.disease [SHS]Humanities and Social Sciences Interquartile range Internal medicine Antithrombotic medicine Cardiology cardiovascular diseases Cardiology and Cardiovascular Medicine business Stroke ComputingMilieux_MISCELLANEOUS Atrial flutter Fibrinolytic agent |
| Zdroj: | Chest Chest, 2011, 140 (4), pp.911-917. ⟨10.1378/chest.10-2436⟩ |
| ISSN: | 0012-3692 1931-3543 |
| Popis: | Background In patients with atrial fibrillation (AF), adherence to guidelines for antithrombotic treatment is poorly followed, and undertreatment (or nonadherence with guidelines) is associated with a worse prognosis. The study objective was to evaluate whether this was also the case in a large contemporary series of unselected patients with AF 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 American College of Cardiology/American Heart Association/European Society of Cardiology guidelines. Results We reviewed outcomes in 3,646 consecutive patients with AF or atrial flutter (aged 71 ± 14 years; mean CHADS 2 [congestive heart failure, hypertension, aged ≥ 75 years, diabetes mellitus, prior stroke or transient ischemic attack] score, 1.5 ± 1.1). Antithrombotic treatment was in agreement with the guidelines in 53% of patients, whereas 31% were classified as undertreated and 16% as overtreated. Among other parameters, nonpermanent AF and atrial flutter were independently associated with an increased risk of undertreatment. After a follow-up of 953 ± 767 days (median, 771 days; interquartile range, 1,286 days), guideline adherence was associated with a lower risk of adverse events (death from all causes or stroke) compared with undertreatment (relative risk, 0.47; 95% CI, 0.40-0.55; P P Conclusions Guideline nonadherence and undertreatment with antithrombotic agents in unselected real-world patients with AF or atrial flutter are independently associated with a high risk of stroke and mortality. |
| Databáze: | OpenAIRE |
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