Results from the Registry of Atrial Fibrillation (AFABE): Gap between Undiagnosed and Registered Atrial Fibrillation in Adults—Ineffectiveness of Oral Anticoagulation Treatment with VKA

Abstract

Objective. This study aimed to examine the effectiveness of the use of oral anticoagulation (OAC) medication, recommended by national guidelines for stroke prevention but reportedly underused in AF patients with moderate to high stroke risk. Method. A multicentre and cross-sectional study of undiagnosed AF among out-of-hospital patients over 60 years old was carried out, visiting 3,638 patients at primary health centres or at home for AF diagnosis using the IDC-10 classification. The main outcome measures were CHA2DS2VASC, HAS-BLED scores, cardiovascular comorbidity, pharmacological information, TTR, and SAMe-TT2R2 scores. Results. The main findings were undiagnosed AF in 26.44% of cases; 31.04% registered with AF but not using OAC despite 95.6% having a CHA2DS2VASC ≥ 2 score; a risk of bleeding in important subgroups using OAC without indication (37.50% CHA2DS2VASC < 2 score); the use of OAC with TTR < 60% (33.1%), of whom 47.6% had a HAS-BLED score ≥3. Thus, 35.4% of the expected AF prevalence achieved an optimal time in the therapeutic range. Conclusions. The expected AF prevalence was 10.9% (n 5267), but the registered prevalence was 7.5% (n 3638). Only 35.04% (CI = 95%, 33.7–36.3) of AF patients treated with vitamin K antagonists (VKAs) achieve the goal of TTR > 60%.

Complex Chronic Patients and Atrial Fibrillation: Association with Cognitive Deterioration and Heart Failure

“…According to the clinical guidelines, if the time in therapeutic range (TTR) cannot be maintained at ≥60% with the use of anti-vitamin K, the use of new oral anticoagulants (NOACs) should be taken into consideration [1]. Internationally, qualitative studies on the treatment with anti-vitamin K have shown poor results in the general practice and untreated patients are associated with atrial fibrillation burden, chronicity, and comorbidity for adverse outcomes [7,[30][31]. In the present study, we observed that 70% of the patients with cognitive deterioration had a TTR of <60%, as well as 60% of patients with heart failure.…”

“…The deficit in the use of anticoagulants in this population is evident and the reasons are little known, although it has been suggested that the clinical criteria used to prescribe oral anticoagulants are different from those indicated by risk scales [7,33]. Despite the clear indication of anticoagulant treatment according to the risk scales, in the daily practice this treatment is often interrupted in complex chronic patients with atrial fibrillation, even though it could contribute to a lower cerebrovascular morbidity and mortality rate [30].…”

“…As a result, from 3 to 4% of the population is composed of complex chronic patients, and one of their risks is the increase in the incidence of atrial fibrillation and/or cognitive deterioration [4][5][6]. It is expected that the number of individuals with atrial fibrillation will increase 150% in the next four decades, especially in individuals aged over 80 years [7]. This way, this disease will be one of the main health economic burdens in the European population.…”

Relationship between Hemorrhagic Stroke and Mortality in Chronic Complex Outpatients: Results from a Community Cohort of Patients

“…It is possible that mortality depends on other factors [38] such as hemorrhage size. Our study includes very old people with cognitive and/or physical disability, and whether hypertension truly increases stroke risk in representative populations of very old people remains unclear because the prevalence of SBP ≥ 160 mmHg is similar (12.0% vs. 11.2%, p 0.407) [39][40][41] in people with and without ADL dependence and cognitive impairment. Confounding factors may obscure the association between BP and incident stroke unless accounted for.…”

Gene–environment interactions in case–control studies with silent disease

“…We note there are numerous diseases that go undiagnosed in a large segment of the population. For example, atrial fibrillation is undiagnosed in 5%-17% of the population above the age of 75 (Panisello-Tafalla et al, 2015), non-alcoholic fatty liver disease is undiagnosed in 14%-30% of the adult population (El-Kader & Ashmawy, 2015), and acute coronary thrombosis is undiagnosed in >10% of individuals at the time of death (Anderson, Hill, & Key, 1989). These frequencies often vary by the environment, e.g., age, sex, race/ethnicity.…”