Gyh. Lip et al., A SURVEY OF ATRIAL-FIBRILLATION IN GENERAL-PRACTICE - THE WEST BIRMINGHAM ATRIAL-FIBRILLATION PROJECT, British journal of general practice, 47(418), 1997, pp. 285-289
Background. The management of atrial fibrillation (AF) has changed sub
stantially in recent years, especially with a greater appreciation of
the prophylactic role of antithrombotic therapy against stroke. There
is therefore a need for further information on the prevalence of AF in
Britain, the prevalence of land contraindications to) anticoagulant t
reatment, and the factors that influence doctors' decisions in treatin
g AF, including the investigation of patients with this arrhythmia. Ai
m. To investigate the prevalence, clinical features and management of
patients with AF in a general practice setting. Method. Cross-sectiona
l survey of patients using treatment prescriptions and clinical record
s in two general practices from the west of Birmingham (serving a pati
ent population of 16 519) where 4522 subjects (27.4%) were aged greate
r than or equal to 50 years. Results. One hundred and eleven (2.4%) pa
tients who were aged greater than or equal to 50 years were found to b
e in AF (42 males; mean age 76.6, SD 9.1); 77.5% were Caucasian, 2.7%
Afro-Caribbean, 0.9% Asian, and 0.9% mixed race; in 20 cases there was
no information on ethnicity. Of the AF patients, 5.4% were aged 50-60
years, 16.2% aged 61-70 years, 20.7% aged 71-75 years, 20.7% aged 76-
80 years, 24.3% aged 81-85 years, and 12.6% aged >85 years old, with f
emale patients being significantly older than males. Eighty-one patien
ts (73%) had chronic AF, while 30 patients (27%) had paroxysmal AF. Th
e most common associated factors were hypertension (36.9%) and ischaem
ic heart disease (28.8%), with no obvious cause for AF in six patients
. Cardiac failure was associated with AF in 34 patients (30.6%), and s
troke had occurred in 29 patients (18%). Only 20 patients (18%) had ha
d an echocardiogram, 26 (23.4%) a chest X-ray, and 58 (52.3%) thyroid
function test. Only 30.6% had ever presented to hospital practice. War
farin was prescribed to 40 patients (36%), with anticoagulation intens
ity monitoring by the general practitioner (GP) in three cases (7.5%),
by a hospital clinic in 30 (75%), and by both GP and hospital in seve
n cases (17.5%). Of those nor anticoagulated (n = 71), only 12 patient
s (16.9%) had contraindications to warfarin therapy. Patients treated
with warfarin were younger than those who were not prescribed warfarin
(71.3 versus 79.6 years, P < 0.001). Aspirin was being prescribed for
21 patients (18.9%), primarily for previous myocardial infarction. On
ly five patients (4.5%) had ever had attempted cardioversion. Conclusi
on. Atrial fibrillation is a common arrhythmia in general practice, an
d is commonly associated with hypertension, ischaemic heart disease an
d heart failure. There is a suboptimal application of standard investi
gations and use of antithrombotic therapy or attempted cardioversion;
and few patients have presented to hospital practice. Guidelines on th
e management of this common arrhythmia in general practice are require
d.