Stroke prophylaxis in high-risk patients with atrial fibrillation: Rhythm vs. rate control strategy

Alessandro Filippi, Massimo Zoni-Berisso, Giuliano Ermini, Maurizio Landolina, Ovidio Brignoli, Gaetano D'Ambrosio, Gianluca Zingarini, Claudio Pedrinazzi

Research output: Contribution to journalArticle

Abstract

Purpose "Rhythm" and "Rate" control strategies require partially different organization, and a different involvement of Specialists and General Practitioners; we verified whether the strategy assignment modified the approach to stroke prophylaxis. Methods Survey in general practice: 233 GPs identified all patients with codified atrial fibrillation (AF) diagnosis, checked the diagnosis (ECG/hospital discharge document), and filled a structured questionnaire on stroke risk-factors, prophylactic therapy, and reasons for warfarin non prescription in CHADS ≥ 2 patients. Data were collected as an "aggregate." Results Population observed: 295,906 patients aged > 14; 6,036 with confirmed AF; 5,888 with complete data about anti-thrombotic prophylaxis are analyzed here. In the "rhythm strategy" group 45.6% of the CHADS score ≥ 2 patients (594) were on warfarin, vs. 73.2% (1,741) in the "rate strategy" group (p <0.0001). Overall reasons for warfarin non-use were significantly different in the two groups: clinical contraindications (12.3% vs. 19.7%), side effects (5.5% vs. 8.5%), patients' refusal (12.2% vs. 15.2%), unreliable patient/care-giver (14.4% vs. 25.9%); reasons were unknown to the GP in 55.6% in rhythm control vs. 30.9% in rate control group. Conclusions Anti-thrombotic prophylaxis in CHADS ≥ 2 patients is different in subjects assigned to the Rhythm vs. the Rate control strategy, as well as reported reasons for warfarin non use. GPs do not know why warfarin is not used in a large percentage of cases, mainly in the rhythm control strategy group. Improving efforts should probably be differently tailored for patients assigned to the "rhythm" or the "rate" control strategy.

Original languageEnglish
Pages (from-to)314-317
Number of pages4
JournalEuropean Journal of Internal Medicine
Volume24
Issue number4
DOIs
Publication statusPublished - Jun 2013

Fingerprint

Atrial Fibrillation
Warfarin
Stroke
Control Groups
General Practice
General Practitioners
Caregivers
Prescriptions
Patient Care
Electrocardiography
Population

Keywords

  • Atrial fibrillation
  • Rate vs. rhythm control
  • Stroke prophylaxis

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Filippi, A., Zoni-Berisso, M., Ermini, G., Landolina, M., Brignoli, O., D'Ambrosio, G., ... Pedrinazzi, C. (2013). Stroke prophylaxis in high-risk patients with atrial fibrillation: Rhythm vs. rate control strategy. European Journal of Internal Medicine, 24(4), 314-317. https://doi.org/10.1016/j.ejim.2013.02.002

Stroke prophylaxis in high-risk patients with atrial fibrillation : Rhythm vs. rate control strategy. / Filippi, Alessandro; Zoni-Berisso, Massimo; Ermini, Giuliano; Landolina, Maurizio; Brignoli, Ovidio; D'Ambrosio, Gaetano; Zingarini, Gianluca; Pedrinazzi, Claudio.

In: European Journal of Internal Medicine, Vol. 24, No. 4, 06.2013, p. 314-317.

Research output: Contribution to journalArticle

Filippi, A, Zoni-Berisso, M, Ermini, G, Landolina, M, Brignoli, O, D'Ambrosio, G, Zingarini, G & Pedrinazzi, C 2013, 'Stroke prophylaxis in high-risk patients with atrial fibrillation: Rhythm vs. rate control strategy', European Journal of Internal Medicine, vol. 24, no. 4, pp. 314-317. https://doi.org/10.1016/j.ejim.2013.02.002
Filippi, Alessandro ; Zoni-Berisso, Massimo ; Ermini, Giuliano ; Landolina, Maurizio ; Brignoli, Ovidio ; D'Ambrosio, Gaetano ; Zingarini, Gianluca ; Pedrinazzi, Claudio. / Stroke prophylaxis in high-risk patients with atrial fibrillation : Rhythm vs. rate control strategy. In: European Journal of Internal Medicine. 2013 ; Vol. 24, No. 4. pp. 314-317.
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AU - Filippi, Alessandro

AU - Zoni-Berisso, Massimo

AU - Ermini, Giuliano

AU - Landolina, Maurizio

AU - Brignoli, Ovidio

AU - D'Ambrosio, Gaetano

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N2 - Purpose "Rhythm" and "Rate" control strategies require partially different organization, and a different involvement of Specialists and General Practitioners; we verified whether the strategy assignment modified the approach to stroke prophylaxis. Methods Survey in general practice: 233 GPs identified all patients with codified atrial fibrillation (AF) diagnosis, checked the diagnosis (ECG/hospital discharge document), and filled a structured questionnaire on stroke risk-factors, prophylactic therapy, and reasons for warfarin non prescription in CHADS ≥ 2 patients. Data were collected as an "aggregate." Results Population observed: 295,906 patients aged > 14; 6,036 with confirmed AF; 5,888 with complete data about anti-thrombotic prophylaxis are analyzed here. In the "rhythm strategy" group 45.6% of the CHADS score ≥ 2 patients (594) were on warfarin, vs. 73.2% (1,741) in the "rate strategy" group (p <0.0001). Overall reasons for warfarin non-use were significantly different in the two groups: clinical contraindications (12.3% vs. 19.7%), side effects (5.5% vs. 8.5%), patients' refusal (12.2% vs. 15.2%), unreliable patient/care-giver (14.4% vs. 25.9%); reasons were unknown to the GP in 55.6% in rhythm control vs. 30.9% in rate control group. Conclusions Anti-thrombotic prophylaxis in CHADS ≥ 2 patients is different in subjects assigned to the Rhythm vs. the Rate control strategy, as well as reported reasons for warfarin non use. GPs do not know why warfarin is not used in a large percentage of cases, mainly in the rhythm control strategy group. Improving efforts should probably be differently tailored for patients assigned to the "rhythm" or the "rate" control strategy.

AB - Purpose "Rhythm" and "Rate" control strategies require partially different organization, and a different involvement of Specialists and General Practitioners; we verified whether the strategy assignment modified the approach to stroke prophylaxis. Methods Survey in general practice: 233 GPs identified all patients with codified atrial fibrillation (AF) diagnosis, checked the diagnosis (ECG/hospital discharge document), and filled a structured questionnaire on stroke risk-factors, prophylactic therapy, and reasons for warfarin non prescription in CHADS ≥ 2 patients. Data were collected as an "aggregate." Results Population observed: 295,906 patients aged > 14; 6,036 with confirmed AF; 5,888 with complete data about anti-thrombotic prophylaxis are analyzed here. In the "rhythm strategy" group 45.6% of the CHADS score ≥ 2 patients (594) were on warfarin, vs. 73.2% (1,741) in the "rate strategy" group (p <0.0001). Overall reasons for warfarin non-use were significantly different in the two groups: clinical contraindications (12.3% vs. 19.7%), side effects (5.5% vs. 8.5%), patients' refusal (12.2% vs. 15.2%), unreliable patient/care-giver (14.4% vs. 25.9%); reasons were unknown to the GP in 55.6% in rhythm control vs. 30.9% in rate control group. Conclusions Anti-thrombotic prophylaxis in CHADS ≥ 2 patients is different in subjects assigned to the Rhythm vs. the Rate control strategy, as well as reported reasons for warfarin non use. GPs do not know why warfarin is not used in a large percentage of cases, mainly in the rhythm control strategy group. Improving efforts should probably be differently tailored for patients assigned to the "rhythm" or the "rate" control strategy.

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