Demographic Characteristics and Patterns of Medication in Atrial Fibrillation Patients in South West Ontario: Insights from a Large Primary Care Database.

Information about current practice in primary care-based management of atrial fibrillation (AF) can help to improve care quality. To assess the epidemiology of AF and current patterns of treatment in order to identify therapeutic trends and aspects of current practice that may allow for care-gap identification. We scrutinized the anonymized records of the South Western Ontario database (SWO) collected between July 2002 and October 2008 for information about the characteristics and management of AF patients. From a population of ~168,000 patients we identified 4922 patients with a diagnosis of AF (2.9%). The recorded prevalence of AF increased with age, from <2% at age <60 years to 6% in the age range 71-75 years and 10% at age ≥81 years. AF patients were characterized by an unfavourable cardiovascular risk profile including widespread hypertension (54% of all cases), coronary artery disease (37%) and heart failure (21%), many cases of which were advanced (New York Heart Association class III or IV). Diabetes (22%) and dyslipidaemia (31%) were also widely prevalent. The most frequently prescribed anti-arrhythmic drugs (AADs) were sotolol (n=798), amiodarone (n=712) and propafenone (n=451). Recorded use of flecainide was relatively low (n=175). Rate control-agents were being prescribed for 1838 patients, beta-blockers for 1311 patients and calcium channel blockers (CCBs) for 784 patients. Use of anticoagulants was higher among patients assigned to AADs than among those assigned to rate-control drugs (>25% vs. ~10%). Overall prescription rates for other concomitant medications were >50% for ACE inhibitors/ARBs, 30-35% for statins and beta-blockers, and 27-29% for diuretics, digoxin and CCBs. These Canadian patients with AF were relatively elderly and had multiple concomitant cardiovascular conditions and medications.