Management of atrial fibrillation by primary care physicians in Germany: baseline results of the ATRIUM registry
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Management of atrial fibrillation by primary care physicians in Germany: baseline results of the ATRIUM registry. / Meinertz, Thomas; Kirch, Wilhelm; Rosin, Ludger; Pittrow, David; Willich, Stefan N; Kirchhof, Paulus; ATRIUM investigators.
in: CLIN RES CARDIOL, Jahrgang 100, Nr. 10, 10.2011, S. 897-905.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Management of atrial fibrillation by primary care physicians in Germany: baseline results of the ATRIUM registry
AU - Meinertz, Thomas
AU - Kirch, Wilhelm
AU - Rosin, Ludger
AU - Pittrow, David
AU - Willich, Stefan N
AU - Kirchhof, Paulus
AU - ATRIUM investigators
PY - 2011/10
Y1 - 2011/10
N2 - BACKGROUND: In contrast to surveys in cardiologist settings, presentation and management of atrial fibrillation (AF) in primary care patients is less well studied.METHODS AND RESULTS: The prospective ATRIUM (Outpatient Registry Upon Morbidity of Atrial Fibrillation) collected data from patients with AF seen by 730 physicians representing a random sample of all primary care physicians in Germany. ATRIUM enrolled 3,667 patients (mean age, 72 ± 9 years; 58% male, mean CHADS(2) score 2.2 ± 1.3), 994 (27.1%) with paroxysmal, 944 (25.7%) with persistent or long-standing persistent and 1,525 (41.6%) with permanent AF (no AF type was specified in 204 patients). Mean duration since initial diagnosis of AF was 61 ± 66 months (median 42, interquartile range 14-88). Reported symptoms included palpitations (43%), shortness of breath (49%), fatigue (49%), dizziness (37%) and angina (20%). Most common concomitant conditions were hypertension (84%), heart failure (43%), coronary artery disease (345%), diabetes (35%) and chronic kidney disease (20%). Prior myocardial infarction was present in 11% of patients, prior stroke in 10% and prior transient ischemic attack in 10%. Antithrombotic medication was used by 93% of the patients (oral anticoagulants, 83%). Rate control therapy was reported in 75% and rhythm control therapy in 33%, often added to rate control. Drugs for rhythm and rate control included ß-blockers (75%), calcium antagonists (15%), digitalis (29%), sodium channel blockers of type IA (quinidine, 1.0%) or IC (flecainide or propafenone, 5%), and potassium channel blockers including amiodarone (11%). In the year prior to enrollment, 46% of the patients had been cardioverted (23% by drugs, 22% electrically), catheter ablation had been performed in 5%, and 10% received a pacemaker or defibrillator. A high proportion (44%) of the patients were hospitalized in the year prior to enrollment.CONCLUSIONS: Patients with AF managed in primary care often receive guideline-conforming therapy including antithrombotic therapy, rate control and rhythm control (numbers given above). Despite this apparent adherence, almost half of the patients were hospitalized in the year prior to enrollment, suggesting that the therapies applied do not stabilize patients sufficiently to keep them out of hospital.
AB - BACKGROUND: In contrast to surveys in cardiologist settings, presentation and management of atrial fibrillation (AF) in primary care patients is less well studied.METHODS AND RESULTS: The prospective ATRIUM (Outpatient Registry Upon Morbidity of Atrial Fibrillation) collected data from patients with AF seen by 730 physicians representing a random sample of all primary care physicians in Germany. ATRIUM enrolled 3,667 patients (mean age, 72 ± 9 years; 58% male, mean CHADS(2) score 2.2 ± 1.3), 994 (27.1%) with paroxysmal, 944 (25.7%) with persistent or long-standing persistent and 1,525 (41.6%) with permanent AF (no AF type was specified in 204 patients). Mean duration since initial diagnosis of AF was 61 ± 66 months (median 42, interquartile range 14-88). Reported symptoms included palpitations (43%), shortness of breath (49%), fatigue (49%), dizziness (37%) and angina (20%). Most common concomitant conditions were hypertension (84%), heart failure (43%), coronary artery disease (345%), diabetes (35%) and chronic kidney disease (20%). Prior myocardial infarction was present in 11% of patients, prior stroke in 10% and prior transient ischemic attack in 10%. Antithrombotic medication was used by 93% of the patients (oral anticoagulants, 83%). Rate control therapy was reported in 75% and rhythm control therapy in 33%, often added to rate control. Drugs for rhythm and rate control included ß-blockers (75%), calcium antagonists (15%), digitalis (29%), sodium channel blockers of type IA (quinidine, 1.0%) or IC (flecainide or propafenone, 5%), and potassium channel blockers including amiodarone (11%). In the year prior to enrollment, 46% of the patients had been cardioverted (23% by drugs, 22% electrically), catheter ablation had been performed in 5%, and 10% received a pacemaker or defibrillator. A high proportion (44%) of the patients were hospitalized in the year prior to enrollment.CONCLUSIONS: Patients with AF managed in primary care often receive guideline-conforming therapy including antithrombotic therapy, rate control and rhythm control (numbers given above). Despite this apparent adherence, almost half of the patients were hospitalized in the year prior to enrollment, suggesting that the therapies applied do not stabilize patients sufficiently to keep them out of hospital.
KW - Adult
KW - Aged
KW - Aged, 80 and over
KW - Analysis of Variance
KW - Anti-Arrhythmia Agents/therapeutic use
KW - Atrial Fibrillation/complications
KW - Cardiac Pacing, Artificial/statistics & numerical data
KW - Catheter Ablation/statistics & numerical data
KW - Chi-Square Distribution
KW - Electric Countershock/statistics & numerical data
KW - Female
KW - Fibrinolytic Agents/therapeutic use
KW - Germany
KW - Guideline Adherence
KW - Health Care Surveys
KW - Hospitalization
KW - Humans
KW - Male
KW - Middle Aged
KW - Physicians, Primary Care/statistics & numerical data
KW - Practice Guidelines as Topic
KW - Practice Patterns, Physicians'/statistics & numerical data
KW - Prospective Studies
KW - Quality of Life
KW - Registries
KW - Thromboembolism/etiology
KW - Time Factors
KW - Treatment Outcome
U2 - 10.1007/s00392-011-0320-5
DO - 10.1007/s00392-011-0320-5
M3 - SCORING: Journal article
C2 - 21533828
VL - 100
SP - 897
EP - 905
JO - CLIN RES CARDIOL
JF - CLIN RES CARDIOL
SN - 1861-0684
IS - 10
ER -