A SURVEY OF ATRIAL-FIBRILLATION IN GENERAL-PRACTICE - THE WEST BIRMINGHAM ATRIAL-FIBRILLATION PROJECT

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.