Advertisement

Drug Therapy for Rate and Rhythm Control in Nonvalvular Atrial Fibrillation: A Cross-sectional Study With Electronic Health Records in a Primary Care Cohort

      Abstract

      Purpose

      The purpose of this study is to describe the pharmacologic management of rate and rhythm and assess which factors are associated with the prescription of these drugs in patients with nonvalvular atrial fibrillation (AF) from the Effectiveness, Safety, and Costs in Atrial Fibrillation study.

      Methods

      This retrospective, cross-sectional study describes the pharmacologic rate and rhythm control management strategies adopted during 2012 in all patients diagnosed as having nonvalvular AF in 2007 to 2011. The data source is the Information System for the Improvement of Research in Primary Care database, which is based on primary care electronic health records. To answer the study objectives, 3 multivariate regression models to assess the independent factors associated with the prescription of these drugs were conducted for 2012. The rate and rhythm control drugs assessed were β-blockers, nondihydropyridine calcium channel blockers, antiarrhythmic agents, and digoxin.

      Findings

      A total of 21,304 patients were diagnosed as having nonvalvular AF; 11,638 (54.6%) had at least one heart rate measure during 2012. Of them, 7777 (66.8%) received one or more rate and/or rhythm control drugs during 2012. Most patients (5751 [73.9%] of 7777) received only one drug for rate and/or rhythm control. Rate control agents were the most frequently used in 2012, with β-blockers the most prescribed group (4091 patients [52.6%]). A variety of different variables were associated with the prescription of rate and/or rhythm control drugs in the multivariate regression models.

      Implications

      The most used pharmacologic treatment of rate and rhythm control in our AF population is β-blockers, indicating that a rate control strategy is preferred in our setting, as widely recommended.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Clinical Therapeutics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Camm A.J.
        • Lip G.Y.H.
        • De Caterina R
        • et al.
        2012 focused update of the ESC Guidelines for the management of atrial fibrillation: An update of the 2010 ESC Guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association.
        Eur Heart J. 2012; 33: 2719-2749
        • Lip G.Y.H.
        • Tse H.F.
        • Lane D.A.
        Atrial fibrillation.
        Lancet. 2012; 379: 648-661
        • Camm A.J.
        • Kirchhof P.
        • Lip G.Y.H.
        • et al.
        Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC).
        Eur Heart J. 2010; 31: 2369-2429
        • Caldeira D.
        • David C.
        • Sampaio C.
        Rate versus rhythm control in atrial fibrillation and clinical outcomes: updated systematic review and meta-analysis of randomized controlled trials.
        Arch Cardiovasc Dis. 2012; 105: 226-238
        • Chen S.
        • Yin Y.
        • Krucoff M.W.
        Should rhythm control be preferred in younger atrial fibrillation patients?.
        J Interv Card Electrophysiol. 2012; 35: 71-80
        • Shariff N.
        • Desai R.V.
        • Patel K.
        • et al.
        Rate-control versus Rhythm-control Strategies and Outcomes in Septuagenarians with Atrial Fibrillation.
        Am J Med. 2013; 126: 887-893
        • Lobos-Bejarano J.M.
        • Del Castillo-Rodríguez J.C.
        • Mena-González A.
        • et al.
        Características de los pacientes y abordaje terapéutico de la fibrilación auricular en atención primaria en España: Estudio FIATE.
        Med Clin (Barc). 2013; 141: 279-286
        • Al-Khatib S.M.
        • Allen LaPointe N.M.
        • Chatterjee R.
        • et al.
        Rate- and Rhythm-Control Therapies in Patients With Atrial Fibrillation.
        Ann Intern Med. 2014; 160: 760-773
        • Van Gelder I.
        • Groenveld H.F.
        • Crijns H.J.
        • et al.
        Lenient versus strict rate control in patients with atrial fibrillation.
        N Engl J Med. 2010; 362: 1363-1373
        • Ulimoen S.R.
        • Enger S.
        • Carlson J.
        • et al.
        Comparison of four single-drug regimens on ventricular rate and arrhythmia-related symptoms in patients with permanent atrial fibrillation.
        Am J Cardiol. 2013; 111: 225-230
        • Bolíbar B.
        • Fina Avilés F.
        • Morros R.
        • et al.
        SIDIAP database: electronic clinical records in primary care as a source of information for epidemiologic research.
        Med Clin (Barc). 2012; 138: 617-621
        • Ramos R.
        • Balló E.
        • Marrugat J.
        • et al.
        Validity for use in research on vascular diseases of the SIDIAP (Information System for the Development of Research in Primary Care): the EMMA study.
        Rev Esp Cardiol (Engl Ed). 2012; 65: 29-37
        • Vinagre I.
        • Mata-Cases M.
        • Hermosilla E.
        • et al.
        Control of glycemia and cardiovascular risk factors in patients with type 2 diabetes in primary care in Catalonia (Spain).
        Diabetes Care. 2012; 35: 774-779
        • Pagès-Castellà A.
        • Carbonell-Abella C.
        • Avilés F.F.
        • et al.
        “Burden of osteoporotic fractures in primary health care in Catalonia (Spain): a population-based study”.
        BMC Musculoskelet Disord. 2012; 13: 79
        • Garcia-Gil M.D.M.
        • Hermosilla E.
        • Prieto-Alhambra D.
        • et al.
        Construction and validation of a scoring system for the selection of high-quality data in a Spanish population primary care database (SIDIAP).
        Inform Prim Care. 2011; 19: 135-145
        • Connolly S.J.
        • Pogue J.
        • Hart R.G.
        • et al.
        Effect of clopidogrel added to aspirin in patients with atrial fibrillation. ACTIVE-A.
        N Engl J Med. 2009; 360: 2066-2078
        • Själander S.
        • Själander A.
        • Svensson P.J.
        • Friberg L.
        Atrial fibrillation patients do not benefit from acetylsalicylic acid.
        Europace. 2014; 16: 631-638
        • Mant J.
        • Hobbs F.D.R.
        • Fletcher K.
        • et al.
        Warfarin versus aspirin for stroke prevention in an elderly community population with atrial fibrillation (the Birmingham Atrial Fibrillation Treatment of the Aged Study, BAFTA): a randomised controlled trial.
        Lancet. 2007; 370: 493-503