Paroxysmal atrial fibrillation in community medicine: Intentions of management and estimation of cost

This study was undertaken to describe the declared management of atrial fib rillation in community medicine in France for patients between 50 and 80 ye ars of age, and to estimate the total cost of treatment for Society in the year 2000. A questionnaire was sent to a sample of 306 private sector cardi ologists, representative for their geographic location: 100 replies were re ceived. Only 10% of cardiologists prescribed a treatment in patients without cardio vascular precedents who had a single regressive episode of atrial fibrillat ion and three quarters of them advised follow-up. This management cost an a verage between 228 and 296 Euros/year. When the episode of fibrillation was persistent at the time of consultation, 82% of practitioners prescribed an tiarrhythmic reduction (amiodarone) after antithrombotic treatment (oral an ticoagulants) followed by an antiarrhythmic therapy (class Ic mainly) with an average cost of 659 to 783 Euros/year. In patients with previous cardiovascular disease, when a first episode of a trial fibrillation was present at the time of consultation, 92% of cardiolo gists prescribed pharmacological reduction with amiodarone, followed by lon g-term therapy when successful for an average cost of 755 to 1 092 Euros/ye ar. All cardiologists requested systematic blood tests to search for thyroid co mplications of amiodarone with an average cost of 59 Euros/year. The costs were high, especially in chronic and recurrent pathology : the co st of treatment of the first two episodes of atrial fibrillation in the ove r 65 age group was 305 million Euros/year.