A group of researchers from the Faculty of Medicine of the University of Porto (FMUP) and CINTESIS – Center for Health Technology and Services Research warns that the most common cardiac arrhythmia in the population, called atrial fibrillation, is not being adequately treated in a very significant percentage of patients.
According to the work published in the British Medical Journal Open (BMJ Open), about 27% of patients with this type of heart rhythm disturbance are not on anticoagulants, although they are indicated for this treatment. Of these, 79% are at high risk of suffering a thrombotic event.
On the other hand, among patients without an indication to receive anticoagulants (only 4.2% of the total), 40% are taking the therapy unnecessarily.
“This study awakens the medical community to a reality in which under-treated and over-treated patients with atrial fibrillation coexist. The undertreated lack therapeutic optimization for stroke prevention. The over-treated are being treated unnecessarily and subject to the adverse effects of this treatment,” says Carlos Martins, a researcher at FMUP/CINTESIS and coordinator of the study.
Also, Susana Pinto, the first author of this work, stresses that “this information is of utmost importance because physicians should be proactive in preventing stroke in patients with atrial fibrillation,” she says.
As the authors emphasize, patients with this arrhythmia are five times more likely to have a stroke and represent 15% of all stroke cases. This therapy aims to prevent episodes of thrombosis in patients at risk, following the CHA2 DS2-VASc score.
Of a total of 63526 patients with atrial fibrillation identified in Northern Portugal, 53% are women. Their ages range from 18 to 107 years (76.5 years on average).
The overwhelming majority (95.8%) is indicated for anticoagulants. Of these, about 40% are being treated with drugs such as warfarin (the most prescribed), which requires periodic laboratory analysis, and about 60% with the new oral anticoagulants, which do not require this control.
According to this study, 3% of the Portuguese aged 40 years or older suffer from atrial fibrillation. This percentage is slightly higher than that recorded in 2010 in a study of prevalence in the Portuguese population (2.5%).
Among the main diseases associated with this arrhythmia, hypertension stands out, coexisting in 77% of the cases, followed by alterations in the lipid profile (52%), diabetes (28%), and heart failure (27%).
The study is authored by Susana Silva Pinto (first author), Andreia Teixeira, Teresa Henriques, and Carlos Martins (FMUP/CINTESIS), as well as Hugo Monteiro, from the Regional Health Administration of the North.