Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2013;66:545-52 - Vol. 66 Num.07 DOI: 10.1016/j.rec.2013.03.003

Prevalence of Undiagnosed Atrial Fibrillation and of That Not Being Treated With Anticoagulant Drugs: the AFABE Study

Josep L. Clua-Espuny a,, Iñigo Lechuga-Duran a, Ramón Bosch-Princep b, Albert Roso-Llorach b, Anna Panisello-Tafalla a, Jorgina Lucas-Noll a, Carles López-Pablo b, Lluïsa Queralt-Tomas a, Emmanuel Giménez-Garcia c, Núria González-Rojas d, Miquel Gallofré López e

a Atención Primaria/Hospitalaria, Institut Català de la Salut, Gerència Territorial Terres de l’Ebre, Tortosa, Tarragona, Spain
b USR Terres de l’Ebre, IDIAP Jordi Gol-IISPV-Fundació Dr. Ferran, Tortosa, Tarragona, Spain
c Economía de la Salut, Antares Consulting, Barcelona, Spain
d Economía de la Salud, Boehringer-Ingelheim España, Sant Cugat del Vallès, Barcelona, Spain
e Pla Director de la Malaltia Vascular Cerebral de Catalunya, Departament de Salut, Generalitat de Catalunya, Barcelona, Spain

Keywords

Atrial fibrillation. Prevalence. Population-based study. CHA2DS2-VASc. HAS-BLED. Anticoagulation for atrial fibrillation.

Abstract

Introduction and objectives

Atrial fibrillation constitutes a serious public health problem because it can lead to complications. Thus, the management of this arrhythmia must include not only its treatment, but antithrombotic therapy as well. The main goal is to determine the proportion of cases of undiagnosed atrial fibrillation and the proportion of patients not being treated with oral anticoagulants.

Methods

A multicenter, population-based, retrospective, cross-sectional, observational study. In all, 1043 participants over 60 years of age were randomly selected to undergo an electrocardiogram in a prearranged appointment. Demographic data, CHA2DS2-VASc and HAS-BLED scores, international normalized ratio results, and reasons for not receiving oral anticoagulant therapy were recorded.

Results

The overall prevalence of atrial fibrillation was 10.9% (95% confidence interval, 9.1%-12.8%), 20.1% of which had not been diagnosed previously. In the group with known atrial fibrillation, 23.5% of those with CHA2DS2-VASc≥2 were not receiving oral anticoagulant therapy, and 47.9% had a HAS-BLED score≥3. The odds ratio for not being treated with oral anticoagulation was 2.04 (95% confidence interval, 1.11-3.77) for women, 1.10 (95% confidence interval, 1.05-1.15) for more advanced age at diagnosis, and 8.61 (95% confidence interval 2.38-31.0) for a CHA2DS2-VASc score<2. Cognitive impairment (15.2%) was the main reason for not receiving oral anticoagulant therapy.

Conclusions

The prevalence of previously undiagnosed atrial fibrillation in individuals over 60 years of age is 20.1%, and 23.5% of those who have been diagnosed receive no treatment with oral anticoagulants.

1885-5857/© 2013 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved

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