Click on the icon on the upper right hand side for the article by Abdallah Mashal, MD, MHA, Amos Katz, MD and Pesach Shvartzman, MD.
IMAJ 2011: 13: November: 666-671
Background: Atrial fibrillation (AF) is the most common arrhythmia in adults and is associated with increased mortality and morbidity.
Objectives: To characterize patients diagnosed with AF in primary care clinics in southern Israel.
Methods: We conducted a cross-sectional study in 14 primary care clinics of the largest health insurance fund in Israel, reviewing the electronic medical records of adults aged ≥ 25 years diagnosed with AF. The prevalence, evaluation, antithrombotic treatment and treatments for rate control/rhythm control were analyzed.
Results: We retrieved the records of 995 patients with a diagnosis of AF; the prevalence of AF was 1.5% (2.5% aged ≥ 45 years). The patients’ mean age was 73.5 ± 1.4 years and 55.3% were female. Vitamin K antagonist (VKA) was prescribed for 591 patients (59%), of whom 8.5% had no international normalized ratio follow-up tests for at least 3 months before our review. Among patients in the VKA treatment group the risk for thromboembolic events was considered to be high, moderate and low in 22% (n=131), 66% (n=391) and 12% (n=69), respectively. Patients with a low Congestive Hypertension Age Diabetes Stroke (CHADS2) score (odds ratio = 0.555, 95% confidence interval 0.357–0.862) and patients who did not receive VKA (OR = 0.601, 95% CI 0.459–0.787) received significantly less rate-control treatment. Of the patients with a low CHADS2 score (< 1) 52.7% received VKA treatment, and 39.4% with a high CHADS2 score (≥ 3) did not receive VKA. A positive correlation between anticoagulation and rate or rhythm control was found.
Conclusions: The prevalence and age distribution of AF in southern Israel are similar to findings in the western world. Many of the patients did not receive appropriate antithrombotic prophylaxis.