A COMMUNITY SURVEY OF PATIENTS WITH ATRIAL-FIBRILLATION - ASSOCIATED DISABILITIES AND TREATMENT PREFERENCES

Background. Anticoagulants are effective in preventing stroke in those with atrial fibrillation, but most patients remain untreated. Aim. To investigate the prevalence of disability, cognitive impairment, and p roblems with compliance in a representative sample of the elderly with atrial fibrillation, and to determine whether they would want treatme nt and how they would like services to be arranged. Method. In a surve y of a random sample of 4843 elderly subjects, those with atrial fibri llation were identified using electrocardiograms. Views on Treatment w ere obtained using a structured interview. Disability was assessed usi ng the Office of Population Censuses and Surveys Disability Scale and cognitive status using the Mini Mental State Examination. General prac titioners were asked, via questionnaire, for their views on each subje ct's compliance. Results. Two hundred and seven elderly people with at rial fibrillation were identified. Almost all subjects expressed a wil lingness to undertake treatment to prevent stroke and preferred blood testing performed outside of hospital. Disability (82.7%), cognitive i mpairment (25.7%), and problems with compliance (25.0%) were common, b ut the prevalence of these difficulties was not substantially differen t from the general elderly population, and in many cases they could be overcome (e.g. only 10% of subjects had problems with compliance and no-one who could help them to comply). Conclusions. Most elderly peopl e with atrial fibrillation would accept treatment to prevent stroke. D isability, cognitive impairment, and problems with compliance may make it difficult to treat this patient group. An increase in the use of a nticoagulants should be accompanied by The development of services app ropriate to this frail population.