Introduction:

Atrial fibrillation is one of the most important health problems in the world due to its high prevalence, morbidity and mortality, and because it is a frequent cause of hospital admission and the main indicator for anticoagulation therapy in primary care.

Objective:

The motivation of our study was to define the percentage of patients with nonvalvular atrial fibrillation treated with oral anticoagulants and their clinical characteristics, calculating risks for embolisms and bleeding in this type of patients and their appropriate therapeutic approach.

Patients and methods:

Descriptive, cross-sectional, retrospective study in patients of a primary care centre with three primary care quotas with a diagnosis of non-valvular atrial fibrillation. Variables: demographic data, personal history (arterial hypertension, diabetes mellitus, dyslipidemia, alcohol addiction, smoking habit, ischemic heart disease, heart failure, cerebrovascular disease, kidney failure, peripheral artery disease and systemic embolism), CHA2DS2-VASc and HAS-BLED scores.

Results:

Out of 4,626 patients, 99 (2.15%) were found to have nonvalvular atrial fibrillation. Average age 77 ± 10 years, 52.5% women and 47.5% men. 33% are not receiving any anticoa- gulation therapy, 53% takes acenocoumarol and the rest (13%) a new oral blood-thinning drug (dabigatran, apixaban or rivaroxaban).

97% of patients present a CHA2DS2-VASc ≥2 risk (high for embolism), of which 30% are not receiving any anticoagulation therapy. 80% of patients present HAS-BLED ≥ 3 risk (high for bleeding), of which 55% is taking acenocoumarol, 25% showing international normalized ratio out of the therapeutic range.

Conclusion:

Nonvalvular atrial fibrillation is one of the main causes of cerebrovascular accidents in our patients. It is shown that anticoagulation therapy in patients with high risk of embolism reduces cerebrovascular accidents by 64% and mortality by 26%. In our field, most patients diagnoses with nonvalvular atrial fibrillation have this risk, but 33% are not taking anticoagulants and 25% are poorly controlled with acenocoumarol (a total of 46% of patients). All this implies that 50% of our patients with non-valvular atrial fibrillation develop a high risk for thromboembolic events due to lack or inadequacy of the treatment.

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