Management of atrial fibrillation by primary care physicians in Germany: baseline results of the ATRIUM registry
Open accessAbstract
BACKGROUND: In contrast to surveys in cardiologist settings, presentation and management of atrial fibrillation (AF) in primary care patients is less well studied. METHODS AND RESULTS: The prospective ATRIUM (Outpatient Registry Upon Morbidity of Atrial Fibrillation) collected data from patients with AF seen by 730 physicians representing a random sample of all primary care physicians in Germany. ATRIUM enrolled 3,667 patients (mean age, 72 ± 9 years; 58% male, mean CHADS(2) score 2.2 ± 1.3), 994 (27.1%) with paroxysmal, 944 (25.7%) with persistent or long-standing persistent and 1,525 (41.6%) with permanent AF (no AF type was specified in 204 patients). Mean duration since initial diagnosis of AF was 61 ± 66 months (median 42, interquartile range 14-88). Reported symptoms included palpitations (43%), shortness of breath (49%), fatigue (49%), dizziness (37%) and angina (20%). Most common concomitant conditions were hypertension (84%), heart failure (43%), coronary artery disease (345%), diabetes (35%) and chronic kidney disease (20%). Prior myocardial infarction was present in 11% of patients, prior stroke in 10% and prior transient ischemic attack in 10%. Antithrombotic medication was used by 93% of the patients (oral anticoagulants, 83%). Rate control therapy was reported in 75% and rhythm control therapy in 33%, often added to rate control. Drugs for rhythm and rate control included ß-blockers (75%), calcium antagonists (15%), digitalis (29%), sodium channel blockers of type IA (quinidine, 1.0%) or IC (flecainide or propafenone, 5%), and potassium channel blockers including amiodarone (11%). In the year prior to enrollment, 46% of the patients had been cardioverted (23% by drugs, 22% electrically), catheter ablation had been performed in 5%, and 10% received a pacemaker or defibrillator. A high proportion (44%) of the patients were hospitalized in the year prior to enrollment. CONCLUSIONS: Patients with AF managed in primary care often receive guideline-conforming therapy including antithrombotic therapy, rate control and rhythm control (numbers given above). Despite this apparent adherence, almost half of the patients were hospitalized in the year prior to enrollment, suggesting that the therapies applied do not stabilize patients sufficiently to keep them out of hospital.
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AF-related symptoms are most commonly fatigue/tiredness and exertional shortness of breath, or less frequently palpitations and chest pain.
“AF-related symptoms are most commonly fatigue/tiredness and exertional shortness of breath, or less frequently palpitations and chest pain.”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [200]
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- Authors
- for the ATRIUM investigators, Meinertz, T., Kirch, W., Rosin, L., Pittrow, D., Willich, S. N., & Kirchhof, P.
- Affiliations
- Universität Hamburg (DE)
- Sanofi (Germany) (DE)
- Technische Universität Dresden (DE)
- University Hospital Münster (DE)
- Corresponding author
- Kirchhof, Paulus
- Venue
- Clinical Research in Cardiology
- Published
- 2011-05-01
- Volume
- 100
- Issue
- 10
- Pages
- 897-905
- ISSN
- 1861-0684 (ISSN-L)
- 1861-0692
- PMC
- PMC3178025
- OpenAlex
- W2025679738
- Cited by
- 91
- References
- 41
- Citations by year
- 2023: 4 · 2022: 1 · 2021: 5 · 2020: 3 · 2019: 4 · 2018: 5 · 2017: 8 · 2016: 6 · 2015: 14 · 2014: 14 · 2013: 12 · 2012: 12
- FWCI
- 8.99
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc
- Locations
- Clinical Research in Cardiology (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion)
- Funders
- Sanofi
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
- Keywords
- atrial fibrillation, primary care management, antithrombotic therapy, oral anticoagulants, rate control, rhythm control, cardioversion, catheter ablation, stroke prevention, CHADS2 score, Germany, comorbidities, hospitalization, quality of care, patient-reported symptoms, cardiac pacemaker
- MeSH terms
- Adult, Aged, Aged, 80 and over, Analysis of Variance, Anti-Arrhythmia Agents, Atrial Fibrillation, Cardiac Pacing, Artificial, Electric Countershock, Female, Fibrinolytic Agents, Germany, Hospitalization, Humans, Male, Middle Aged, Practice Patterns, Physicians', Prospective Studies, Quality of Life, Registries, Thromboembolism, Time Factors, Chi-Square Distribution, Treatment Outcome, Catheter Ablation, Practice Guidelines as Topic, Health Care Surveys, Guideline Adherence, Physicians, Primary Care
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