Atrial fibrillation patients often receive needless treatment

Aug 29 2004

Results of the Euro Heart Survey on atrial fibrillation (AF), demonstrate that many AF patients receive clot-preventing drugs while not at risk for stroke.

Also, patients are given rhythm control drugs despite the fact that they never were symptomatic. These drugs may induce intracranial bleeding as well as sudden death, respectively. Insight into the data of this survey may help reducing redundant and potentially dangerous treatments in AF patients.

AF is a frequent disorder occurring particularly in elderly patients. It may be secondary to hypertension, coronary artery disease, heart failure or valvular heart disease, but it can also occur in patients without heart disease. In 2004 a survey on AF was conducted in 182 centers from 35 ESC countries. Data was collected on characteristics and management of 5334 patients.

Since patients with AF have an increased risk for stroke, clot-preventing drugs are recommended. Yet, the survey revealed that 34% of 4279 eligible patients did not receive these agents. 559 patients were found to have a low stroke risk. Of these patients 55% were prescribed vitamin K antagonists by their doctor, their average age was 54 years. This clearly indicates overuse of this potentially dangerous drug. In this case, overuse either relates to inappropriate application of risk stratification schemes and maybe also to fear for stroke in the young with AF.

The guidelines for AF of the European Society of Cardiology say that rhythm control drugs should not be given to patients who are asymptomatic with their AF. Instead, asymptomatic patients should receive simple rate controlling drugs like beta-blockers, digitalis or verapamil. There were 858 patients who had never experienced complaints with their arrhythmia. Of these approximately 40% were under rhythm control with drugs and electrical shocks to restore and maintain the normal heart rhythm. Several large scale studies have shown that such an approach does not improve patients’ prognosis compared to rate control, and may even put them at risk of heart failure, proarrhythmia (aggravation of arrhythmia problem) or heart block. Risk factors for these problems include presence of heart failure and coronary artery disease as a cause of AF. Out of 495 patients on so-called class Ic drugs, more than 12% had at least one proarrhythmia risk factor. As above, lack of application of guidelines may have led to needless and potentially dangerous therapy.

The Euro Heart Survey programme has been inititiated by the European Society of Cardiology (ESC) to collect data on the epidemiology, management and outcome of a broad spectrum of cardiovascular diseases in a series of surveys. By analysing these data the ESC aims to get clear insight into the epidemiology of cardiovascular diseases, in the adherence to existing European practice guidelines on the diagnosis, treatment and prevention of cardiovascular diseases, in the application of clinical trial results in clinical practice and in regional differences across participating ESC member countries. Through these insights the EHS is expected to contribute to facilitating the implementation of evidence-based medicine, with the ultimate aim to improve patient management, and consequently patient outcome, and to develop cost-effective patient management.

The current survey contributed to these goals by highlighting that following simple rules from the guidelines may help to avoid redundant therapies. Avoiding needless treatment ensures patients’ quality of life and may help to reduce health care costs.