Risk factors for stroke and thromboprophylaxis in atrial fibrillation: what happens in daily clinical practice? The GEFAUR-1 study

Differences among Clinical Classification Schemes for Predicting Stroke in Atrial Fibrillation: Implications for Therapy in Daily Practice

“…Such differences are explained by variations in the prevalence of risk factors for stroke among patients from clinical trials on whom the CCSs are based, and the daily practice population in which the CCSs are applied. 4,[12][13][14][15][16] Thus, ED patients are older, with a higher prevalence of age-related comorbidity (hypertension, diabetes), compared with those included in clinical trials on stroke prophylaxis in NVAF. 11,20 When the lack of agreement in the estimation of risk is transferred to clinical practice, and an analysis is made of the classification of patients into two groups, low risk (indication for antiplatelet therapy) and moderate to high risk (eligible for anticoagulation), the disparity in classification means that the number of patients for whom anticoagulation must be prescribed would vary as much as 33% (from 91% [AFI] to 58% [CHADS 2 ]).…”

“…4,16 In our study, the prescription of anticoagulation as stroke prophylaxis by the treating physicians was insufficient and did not follow the risk stratification provided by any of the widespread CCSs. Although the efficacy of anticoagulation has been demonstrated in numerous clinical trials, 11 various studies have highlighted a low prescription in various daily practice settings such as hospitals, 24,25 primary care, 26 EDs, 16,27 and geriatric units. 28 Thus, in daily practice, anticoagulation is prescribed to only 15-44% of eligible patients, 29 consistent with the 24% of prescriptions found in our study.…”

“…Detailed descriptions of the GEFAUR studies' methodology and the characteristics of emergency medicine in Spain have been published elsewhere. 16,17 Briefly, the GEFAUR-1 was a prospective, multicenter, observational study performed in the EDs of 12 hospitals of the National Health System in Madrid, Spain, between June 15 and August 1, 2000; and GEFAUR-2 was carried out in the same way in four of these hospitals between February 1 and 15, 2001. Both studies were promoted by the Scientific Committee of the Spanish Society of Emergency Medicine (SEMES).…”

“…14,15 Emergency departments (EDs) account for a large, and increasing, number of visits of patients with NVAF. 16 In this setting, the conditions of the ED and the patients' clinical profiles are different from the highly selected study populations and conditions of clinical trials, and could provide helpful information about the real management of NVAF in daily clinical practice.…”

Cardioversion of recent-onset atrial fibrillation and flutter in the emergency department

“…Atrial fibrillation (AF) is the most common arrhythmia encountered in acute medical practice, occurring in 3.3%-10% of emergency admissions [1][2][3][4]. In some of these cases, AF is longstanding and/or incidental to clinical management, but more often AF has developed acutely as either the primary clinical problem or as a complication of another acute (pneumonia, myocardial infarction, septicaemia, pulmonary embolism, exacerbations of chronic obstructive pulmonary disease etc) or chronic (valvular heart disease, hypertension, heart failure, cardiomyopathies, etc) diseases.…”