Conventional treatment of atrial fibrillation in the Czech Republic managed by outpatient cardiologists. Overview of diagnostic and treatment procedures, pharmacological treatment and hospitalisation.
Authors:
V. Bulková 1,2; M. Fiala 3; J. Chovančík 3; D. Wichterle 4; R. Čihák 4; M. Branny 3; J. Kautzner 4
Authors‘ workplace:
II. interní klinika 1. lékařské fakulty UK a VFN Praha, přednosta prof. MUDr. Aleš Linhart, DrSc.
1; Ústav sociálního lékařství a zdravotní politiky Lékařské fakulty UP Olomouc, přednosta prof. MUDr. Ivan Gladkij, CSc.
2; Oddělení kardiologie Nemocnice Podlesí, a. s., Třinec, přednosta prim. MUDr. Marian Branny
3; Klinika kardiologie IKEM Praha, přednosta prof. MUDr. Jan Kautzner, CSc., FESC
4
Published in:
Vnitř Lék 2008; 54(1): 36-44
Category:
Original Contributions
Overview
Objective:
The aim of the study was to analyse general health data, diagnostic and therapeutic procedures, pharmacological treatment and hospitalization of patients with atrial fibrillation (AF) who did not undergo AF catheter ablation and were in the care of outpatient cardiologists.
Method:
Data concerning 306 patients (of which 94 women, aged 64 ± 11 years) for the preceding 2 years were acquired through a questionnaire containing a set of standardized questions on a simple form sent out to outpatient cardiologists.
Results:
AF was paroxysmal, persistent or permanent in 141 (46 %), 77 (25 %) or 88 (28%) patients, respectively. The higher the age, the lower the proportion of paroxysmal AF and the higher the proportion of the permanent form of AF. AF was asymptomatic in 122 (39%) of patients. The most frequent among cardiovascular diseases was hypertension, detected in 220 patients (72 %), IHD was present in 83 patients (27 %). The mean LV EF was 55 ± 11 % and was significantly lower in patients with permanent AF than in patients with paroxysmal AF (∅ 51 ± 13 % vs. ∅ 58 ± 9 %, P < 0,001). The mean left atrium transversal diameter was 47 ± 7 mm and was significantly higher in patients with permanent AF than in those with paroxysmal AF (50 ± 8 mm vs. 44 ± 6 mm, P < 0,001). 230 patients (75 %) received anticoagulation treatment and 43 patients (14%) received antiaggregation treatment. 274 patients (90 %) were taking antiarrhythmic drugs (AA); 93 patients were taking 1, 168 patients 2 and 13 patients 3 AA drugs. 167 patients (55%) underwent electrical cardioversion in 362 procedures, 106 patients (35%) underwent pharmacological cardioversion in 239 procedures. Coronarography was performed in 79 patients (26 %) of which 59 (75 %) had normal results for coronary arteries. Pacemaker due to concomitant sinus node dysfunction was implanted to 27 patients (9%). Ablation for concomitant atrial flutter of type I was performed in 42 patients (14 %). AF and associated conditions caused 250 hospitalisations in 144 patients (47%). The average length of hospitalisation was 4.2 ± 3.2 days. Cardioembolic event was the cause of hospitalisation of 25 patients (8 %) out of 29 hospitalisations with the mean length of hospital stay 8.2 ± 2.9 days.
Conclusion:
The study has shown, in the first place, very high standards of anticoagulation and antiarrhythmic treatment. It has also shown a relatively frequent indication for coronarography, pacemaker implant for relative sinus node dysfunction or ablation for concomitant atrial flutter of type I, i.e. intervention procedures with limited benefit for AF patients.
Keywords:
atrial fibrillation – diagnostic procedures – treatment procedures – pharmacological treatment – hospitalisation
Sources
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