[NON-VALVULAR ATRIAL FIBRILLATION AT THE DEPARTMENT OF INTERNAL MEDICINE].

BACKGROUND

Most of the data on atrial fibrillation is known from registries including mostly ambulatory patients. Less is known about atrial fibrillation among patients hospitalized at departments of medicine.

OBJECTIVES

To explore the characteristics of atrial fibrillation in patients hospitalized at the departments of medicine, and their management during hospitalization, focusing on anticoagulation treatment.

METHODS

A retrospective study was conducted based on reviewing patient charts at the departments of medicine of a tertiary medical center. Inclusion criteria: patients with non-valvular atrial fibrillation hospitalized during a period of 3 months. The following parameters were collected: age, gender, co-morbidities, cause of index admission, mean hemoglobin, platelets and creatinine levels, CHA2DS2-VASc and HAS-BLED scores and INR levels; rhythm/rate control strategy, anticoagulation and anti-platelets treatments were documented at admission and discharge.

RESULTS

The study group consisted of 404 subjects, who had 735 admissions. Mean age was 76±12 years, half were male. The most common co-morbidity was hypertension (73%). Most patients (90%) were diagnosed with atrial fibrillation previous to current admissions, and were at high risk for embolization (CHA2DS2-Vasc ≥3 - 86%) and bleeding (HASBLED ≥ 3 -79%). On admission, in three quarters of the cases patients with established atrial fibrillation were treated by rate control, 45% were not treated by anticoagulants. The therapeutic strategy of rate control or anticoagulation treatment did not change significantly during hospitalization. The rate of anticoagulation treatment did not differ significantly between CHA2DS2-VASc levels. The most predictive parameter for anticoagulants treatment at discharge was previous anticoagulation treatment.

CONCLUSIONS

The effect of hospitalization on atrial fibrillation treatment policy is poor. Future registries of hospitalized patients with atrial fibrillation, as well as therapeutic interventions are needed.