Department of Cardiology, Maggiore Hospital, Bologna, Italy.
Int J Cardiol. 2013 Sep 10;167(6):2895-903. doi: 10.1016/j.ijcard.2012.07.019. Epub 2012 Aug 11.
Atrial fibrillation (AF) is associated with a high risk of stroke and mortality.
To describe the difference in AF management of patients (pts) referred to Cardiology (CARD) or Internal Medicine (MED) units in Italy.
From May to July 2010, 360 centers enrolled 7148 pts (54% in CARD and 46% in MED). Median age was 77 years (IQR 70-83). Hypertension was the most prevalent associated condition, followed by hypercholesterolemia (28.9%), heart failure (27.7%) and diabetes (24.3%). MED pts were older, more frequently females and more often with comorbidities than CARD pts. In the 4845 pts with nonvalvular AF, a CHADS2 score ≥ 2 was present in 53.0% of CARD vs 75.3% of MED pts (p<.0001). Oral anticoagulants (OAC) were prescribed in 64.2% of CARD vs 46.3% of MED pts (p<.0001); OAC prescription rate was 49.6% in CHADS2 0 and 56.2% in CHADS2 score ≥ 2 pts. At the adjusted analysis patients managed in MED had a significantly lower probability to be treated with OAC. Rate control strategy was pursued in 51.4% of the pts (60.5% in MED and 43.6% in CARD) while rhythm control was the choice in 39.8% of CARD vs 12.9% of MED pts (p<.0001).
Cardiologists and internists seem to manage pts with large epidemiological differences. Both CARD and MED specialists currently fail to prescribe OAC in accordance with stroke risk. Patients managed by MED specialists have a lower probability to receive an OAC treatment, irrespective of the severity of clinical conditions.
心房颤动（AF）与中风和死亡率的风险增加有关。
描述意大利心脏病学（CARD）或内科（MED）科室就诊的患者（pts）的 AF 管理差异。
2010 年 5 月至 7 月，360 个中心纳入了 7148 名患者（54%在 CARD，46%在 MED）。中位年龄为 77 岁（IQR 70-83）。高血压是最常见的相关疾病，其次是高胆固醇血症（28.9%）、心力衰竭（27.7%）和糖尿病（24.3%）。MED 患者年龄较大，女性较多，合并症较多。在 4845 名非瓣膜性 AF 患者中，CARD 患者的 CHADS2 评分≥2 占 53.0%，而 MED 患者的 CHADS2 评分≥2 占 75.3%（p<.0001）。CARD 患者中有 64.2%的患者开具了口服抗凝剂（OAC），而 MED 患者中有 46.3%的患者开具了 OAC（p<.0001）；在 CHADS2 0 患者中，OAC 处方率为 49.6%，在 CHADS2 评分≥2 患者中，OAC 处方率为 56.2%。在调整分析中，在 MED 治疗的患者接受 OAC 治疗的可能性明显较低。51.4%的患者采用了心率控制策略（60.5%在 MED，43.6%在 CARD），而 39.8%的 CARD 患者采用了节律控制策略，而 MED 患者中只有 12.9%采用了节律控制策略（p<.0001）。
心脏病专家和内科医生似乎对具有较大流行病学差异的患者进行管理。CARD 和 MED 专家目前都未能根据中风风险开具 OAC。无论临床情况的严重程度如何，由 MED 专家管理的患者接受 OAC 治疗的可能性较低。
