Management of patients with atrial fibrillation by primary-care physicians in Germany: 1-year results of the ATRIUM registry

Abstract

Background: Patients with atrial fibrillation (AF) in Germany are often managed jointly by primary-care physicians in cooperation with cardiologists. We aimed to investigate the management and 1-year outcomes of AF patients in this setting.

Hypothesis: We set out to describe the current management of AF patients in primary care settings in Germany.

Methods: Observational registry with 1-year follow-up, performed by a representative, randomly selected sample of 781 primary-care physicians in Germany.

Results: Of 3781 patients with electrocardiographically documented AF, 3163 patients (age 71.9 ± 9.2 years, 57.9% males) were followed for 1 year; 28.4% had paroxysmal, 27.0% persistent, and 43.3% permanent AF. Comorbid conditions were common (mean CHA2 DS2-VASc score 3. 8 ± 1.7). Rhythm-control therapy was used in 16.4%. Although oral anticoagulation was often used (82.7% at baseline), stroke rate during follow-up was high (2.7% stroke, 3.0% transient ischemic attack). Despite a long duration of AF (mean duration 61 months at enrollment), 18.5% of patients were hospitalized during the 1-year follow-up.

Conclusions: In this unselected group of patients with long-standing AF managed in primary care, hospitalizations and cardiovascular complications including strokes are frequent, illustrating the need to improve management of AF patients.

Figure 1

Medications for rate and rhythm control of atrial fibrillation at baseline and at 1‐year follow‐up.

Figure 2

Anticoagulation, by eligibility status according to CHA₂DS₂‐VASc score. Eligible for antithrombotic therapy is defined as 0 points according to CHA₂DS₂‐VASc score, possibly eligible as 1 point, eligible as 2+ points. OAC indicates patients receiving vitamin K antagonists alone or in any combination with antiplatelets and/or LMWH. Abbreviations: BL, baseline; CHF, congestive heart failure; DM, diabetes mellitus; FU, follow‐up at 1 year; LMWH, low‐molecular‐weight heparin; OAC, oral anticoagulation; TIA, transient ischemic attack. The CHA₂DS₂‐VASc score refines the original CHADS₂ score (CHF, hypertension, age ≥75 years, DM, and prior stroke, TIA, or thromboembolism) by adding vascular disease, age 65 to 74 years, and sex category.

Figure 3

Frequency of hospitalizations per patient during follow‐up, regardless of underlying cause.

Figure 4

Reasons for hospitalizations during follow‐up. Abbreviations: AF, atrial fibrillation; ICD, implantable cardioverter‐defibrillator; TIA, transient ischemic attack.