The frequency of embolic risk factors and adequacy of anti-embolic treatment in patients with atrial fibrillation: a single tertiary center experience

Objective: Though atrial fibrillation (AF) is the most common sustained arrhythmia permanently; there is not enough data about the prevalence, frequency of risk factors, and adequacy of anticoagulant therapy. We aimed to investigate the prevalence of AF, the frequency of risk factors, adequacy of anticoagulant therapy in patients who were admitted to our outpatient tertiary cardiology clinic according to current guidelines. Methods: Patients, admitted to our Cardiology outpatient clinic between January - June 2010 and had a history of AF were included to the study retrospectively. Patients’ demographic findings, clinical AF classification, CHA2DS2VASC scores, treatments the measured INR values in last 12 months retrospectively and the success of anticoagulant therapy were evaluated. Results: Overall, 432 (9.1%) of 4721 patients had AF. Among them 253 (58.5%) patients were female, mean age was 70.4 years. Permanent AF was the most common type. The most common risk factor was hypertension (71.9%). CHA2DS2VASC score was ≥ 2 in 377 patients (87.2%) and 254 (67.3%) of those patients had absolutely indicated for anticoagulation therapy, were taking warfarin. Sixteen of 37 patients with one risk factor, and 10 of 18 patients without risk factors were also receiving warfarin. Although warfarin was indicated in 123 patients, 36 patients had contraindications, 13 patients refused anticoagulation, and warfarin was stopped in 5 patients because of noncompliance with treatment. 15.9% of patients were not on warfarin although anticoagulation was indicated and no contraindication. 83.5% patients INR levels were between therapeutic ranges. Conclusion: Anticoagulation is applied successfully among an important part of AF patients in our tertiary center, but in a substantial group of patients the guidelines are still not implemented. New, cost-effective, safe, accessible treatments are needed for warfarin contraindicated patients.