Risk factors for stroke and thromboprophylaxis in atrial fibrillation: what happens in daily clinical practice? The GEFAUR-1 study☆☆☆★★★☆☆☆
Received 16 July 2003; received in revised form 3 November 2003, 18 December 2003 and 31 December 2003; accepted 6 January 2004.
Abstract
Study objectives
We determine the risk for stroke of patients with atrial fibrillation in the emergency department (ED) and analyze the use of stroke prophylaxis in this setting.
Methods
This was a cross-sectional study carried out in 12 EDs. Clinical variables, risk factors for stroke, the prophylaxis prescribed, and the reasons for not initiating anticoagulation were collected. Risk factors and indications for therapy were evaluated according to the American College of Chest Physicians' 1998 recommendations.
Results
Of 1,178 patients included, 69% were not taking anticoagulants. Of the latter, 89% patients had indications for anticoagulation (age >75 years 59%, hypertension 56%, cardiac disorders 29%, heart failure 22%, diabetes 22%, previous embolism 14%), and 63% of the patients had 2 or more risk factors. Anticoagulation was prescribed in the ED to 27% of patients (67% with warfarin, 33% low-weight heparin plus warfarin), antiplatelets to 20% of patients, and no thromboprophylaxis to 53% of these eligible patients. Anticoagulants were prescribed in only 9% of patients with risk factors and current prophylaxis with antiplatelet agents. The main reasons for not prescribing anticoagulation in the presence of risk factors were advanced age (11%), contraindication for anticoagulation (27%), or because it was not considered to be indicated by the physicians (23%).
Conclusion
Most patients seen in the ED with atrial fibrillation are at high risk of stroke. Despite this risk, anticoagulation is underused in this setting, mainly because of the influence of advanced age on medical decisions and the reluctance to change current antiplatelet therapy.
Available online April 27, 2004.
From the Scientific Committee, Spanish Society of Emergency Medicine, Madrid, Spain
Address for correspondence: Alfonso Martı́n, MD, Emergency Department, Hospital de Móstoles, c/Rı́o Júcar s/n, 28935-Móstoles, Madrid, Spain; 34 91 664 87 07; fax 34 91 664 87 65
☆ The participating investigators are listed in the Appendix.
☆☆ Author contributions: AM, CG, PL, and PG conceived and designed the study. AM supervised the conduct of the study and the data collection and was responsible for the design and codification of the data collection sheet. CG provided statistical advice on study design and the data analysis. CG, AM, and PL drafted the manuscript and take responsibility for the paper as a whole.
★ Presented in part as an abstract at the XXIV Congress of the European Society of Cardiology, Berlin, Germany, September 1-4, 2002.
★★ Supported by an unintentional grant of 3M-Spain, which was not involved in any other way in the development of this study and had no influence in the contents of the article.
ABSTRACT