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A. Basics
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01. History of Cardiology
02. Clinical Skills
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05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
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21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
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25. Interventional Cardiology
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28. Risk Factors and Prevention
29. Rehabilitation and Sports Cardiology
30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
33. e-Cardiology / Digital Health
34. Public Health and Health Economics
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A glimpse at the management of atrial fibrillation - an assessment of standard of care
Session:
Posters (Sessão 5 - Écran 1) - Fibrilhação auricular - clínica
Speaker:
Joana Silva Ferreira
Congress:
CPC 2023
Topic:
C. Arrhythmias and Device Therapy
Theme:
05. Atrial Fibrillation
Subtheme:
05.8 Atrial Fibrillation - Clinical
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Joana Silva Ferreira; Leonor Parreira; Ana Fátima Esteves; Rui Antunes Coelho; Jéni Quintal; José Maria Farinha; Dinis Mesquita; Pedro Amador; Rita Marinheiro; Cátia Costa; Rui Caria
Abstract
<p><strong>Background: </strong>Atrial fibrillation (AF) is the most common arrhythmia. However, its treatment is still heterogeneous since clinical guidelines are not always strictly followed.</p> <p> </p> <p><strong>Purpose:</strong> to describe the management and long-term outcomes of ‘real-life’ patients with AF in our center.</p> <p> </p> <p><strong>Methods: </strong>We retrospectively analyzed admissions to the Emergency Department (ED) in 2016 with the International Classification of Diseases codes correspondent to AF. Patients older than 75 years and those whose electronic medical file was not accessible were excluded. We divided our sample into 3 groups according to patient status at index admission: A) patients presenting with first-diagnosed AF; B) patients presenting with previously-diagnosed AF under rhythm control strategy; and C) those with previously-diagnosed AF under rate control strategy. We assessed patient characteristics, treatment strategies as well as readmissions to the ED, stroke and all-cause mortality.</p> <p> </p> <p><strong>Results: </strong>Of the 346 patients initially screened, 252 were excluded, resulting in a sample of 94 patients with a median age of 65 years and median CHA2DS2-VASc of 2. The majority (68%) presented with first-diagnosed AF (group A), while 18% were already under rhythm control medication (group B) and the remaining 14% under rate control therapy (group C). At discharge, the majority was adequately anticoagulated and unnecessary anticoagulation of low stroke-risk patients was the most common mistake in anticoagulation.</p> <p>After a median of 2 months from diagnosis, half the patients with first-diagnosed AF were started on antiarrhythmic drugs, significantly earlier than those who already had previously-known AF. Nearly half the patients in group B underwent catheter ablation, after failure of 2 antiarrhythmic drugs, while those with first-diagnosed AF (group A) were submitted to the procedure significantly earlier (after failure of 1 antiarrhythmic drug). </p> <p>At 1-year follow-up, all-cause mortality and stroke rates were low. At a median follow-up of 5 years, readmissions for AF were common but readmission-free survival was significantly superior among the patients in group A (Kaplan-Meier with log-rank test: p=0.02).</p> <p> </p> <p><strong>Conclusion</strong>: This study suggests that the management of AF in our center is mostly in accordance with European AF guidelines. The timing of referral for catheter ablation was slightly delayed (after failure of the second antiarrhythmic drug) compared with the 2020 recommendations but in line with those from 2016. Mortality and stroke rates were low and readmission rates for AF were similar to those reported in other registries. The lower readmission rate in first-diagnosed AF suggests symptom control may be improving, perhaps due to earlier adoption of a rhythm control strategy.</p>
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