Jornal Médico – U.Porto study points out flaws in the treatment of atrial fibrillation

A very significant percentage of patients with atrial fibrillation — the most common cardiac arrhythmia in the population — are not being adequately treated. The alert was made public today by a group of researchers from the University of Porto (U.Porto), following work published in the British Medical Journal Open (BMJ Open).

According to the aforementioned research, now reported by the Lusa agency, around 27% of patients with this type of heart rhythm alteration are not undergoing anticoagulation, although they have “an indication to receive this treatment”. Of this universe, 79% have “high risk of suffering a thrombotic event”.

Researchers from the Faculty of Medicine of the University of Porto (FMUP) and from CINTESIS – Center for Research in Health Technologies and Services let it be known that, among patients with no indication to receive anticoagulants (only 4.2% of the total), 40% is undergoing unnecessary treatment.

“This study awakens the medical community to a reality in which undertreated patients with atrial fibrillation coexist and overtreated patients”, underlines, in a statement, the researcher from FMUP/CINTESIS and coordinator of the study, Carlos Martins. The first ones, in fact, “need therapeutic optimization for the prevention of cerebrovascular accident (CVA)”. On the other hand, in the second case, the patients are being treated unnecessarily and subject to the adverse effects of that treatment”.

Susana Silva Pinto, first author of this work, reiterates that “this information is of utmost importance because physicians must be proactive in preventing stroke in patients with atrial fibrillation”, clarifying that “the objective of this therapy is to prevent episodes of thrombosis in patients with risk, following the ‘score’ CHA2 DS2 – VASc”.

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In light of currently known information, the Northern Region of Portugal has identified 63,526 patients with atrial fibrillation, of which 53% are women, in a well-extended age group 18-107 years (76.5 years on average). The risk of stroke in this universe with cardiac arrhythmia is five times higher, representing 15% of all cases of this pathology.

It happens, the U.Porto researchers explain, that most of the individuals identified “(95.8%) are indicated for anticoagulation”, and, in this group, approximately “40% are being medicated with drugs such as warfarin ( the most prescribed)” — ​​subject to periodic laboratory analysis — “and about 60%” are receiving “the new oral anticoagulants, which do not require this control”.

Atrial fibrillation affects, according to this research, 3% per cent of Portuguese aged 40 years and over. An arrhythmia associated with comorbidities, mainly hypertension (in 77% of cases), changes in lipid profile (52%), diabetes (28%) and heart failure (27%).

Susana Silva Pinto, Andreia Teixeira, Teresa Henriques and Carlos Martins, representing the FMUP/CINTESIS, and Hugo Monteiro, from the North Regional Health Administration, make up the team that participated in this study.


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