Adherence to guidelines and mortality in atrial fibrillation

•In real world adherence to guidelines for management of atrial fibrillation is poor.•Adherence to guidelines improves survival up to three years.•Use of oral anticoagulants improves survival.•The rate control was the prevailing used strategy.•Survival during the first year was higher with rate control strategy.

ObjectiveDetermining the adherence to ACC/AHA/ESC 2006 guidelines and its influence on the survival of patients with atrial fibrillation.MethodsProspective observational study of patients discharged during 2007 from an Internal Medicine department with a main or secondary diagnose of atrial fibrillation. The stroke risk was estimated with the CHADS2 score. The follow-up was carried out in outpatient medical office or via telephone.ResultsWe included 259 patients (mean age 80.9 years); 73% of them had a high risk of stroke. Oral anticoagulants were administered to 134 (51.7%), and antiplatelet drugs to 71 (27%) patients. A rate control strategy was chosen for 155 (59.8%) patients and a rhythm control one for 28 (10.8%). In 100 (38.6%) patients, treatment was adherent to the guidelines. Adherence to the guidelines was associated with age (0.95 95%CI 0.92-0.99; p = 0.03), contraindication to the use of oral anticoagulants (0.38 95%CI 0.18-0.81; p = 0.01) and mitral valve heart disease/valvular prosthesis (2.10 95%CI 1.04-4.25; p = 0.04). The median follow-up was 727 days, and 191 patients died. Patients treated according to the guidelines had a higher rate of survival during the first three years (0.47 vs. 0.36; p = 0.049). The use of oral anticoagulants was associated with a higher probability of survival over a 5 year period (0.34 vs 0.21; p = 0.001) and the rate control strategy during the first year (0.69 vs 0.57; p = 0.04).ConclusionsIn the real world, the treatment of atrial fibrillation according to the guidelines is associated with improved survival for up to three years during follow-up.