Extrahospitalary management of atrial fibrillation and its adaptation to clinical practice guidelines
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Abstract
Objective: To study the variability in the management of atrial fibrillation (AF) by emergency teams and their adherence to treatment guidelines.
Material and method. Descriptive study of AF episodes treated in two years of Cadiz. We studied 236 patients. We analysed the patient's history, the clinical care provided by the team and the results of frequency and rhythm control. We constructed a synthetic index of therapeutic adequacy (SITA) with a range of -3 to 3.
Results. 236 patients reviewed, 68% were men, women were younger (66 vs 75 years), 43.8% were first episodes; most frequent comorbidities were HBP (64%), heart disease (41.1%) and diabetes (30.1%). The most widely used drug is amiodarone. 16.1% of attendances presented complete adherence (SITA=3) and 63.1%, positive partial GCP adaptation (SITA=1 or 2); the greatest clinical variability occurred in bradycardisation. The adaptation was: 62.3% for anticoagulation, 68.2% for bradycardisation and 56.8% for cardioversion. There was 40.7% frequency control and 96% hospital referral.
Conclusion. We must increasing anticoagulation and using beta-blockers and calcium-antagonists to replace amiodarone. ISAT allows the evaluation of the adequacy of CPG to control symptoms, heart rate and reduce stays in the emergency services.
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