Introduction and objectives: The guidelines for the management of atrial fibrillation (AF) incorporate new risk factors for thromboembolism, trying to de-emphasize the use of the 'low', 'moderate', and 'high' risk categories. The objective of this study was to determine the impact of the new scheme CHA₂DS₂-VASc and of the new recommendations for oral anticoagulation (OAC) in a contemporary sample of patients with AF seen by primary physicians and cardiologists.
Methods: Multicenter, observational, cross-sectional study on the epidemiology of hypertension and its control, designed by the arterial hypertension department. Each researcher enrolled the first 6 consenting patients who came for examination during a 5-day period.
Results: Of 25 137 individuals recruited, 1544 were diagnosed with AF. The vast majority of the sample had a CHADS₂ score ≥2 (77.3%). Individuals with a risk score lower than 2 were categorized according to the CHA₂DS₂-VASc score: 14.4% were aged 75 years or older (CHA₂DS₂-VASc=2). Of those younger than 75, 42.3% had a CHA₂DS₂-VASc=2; 23.7% CHA₂DS₂-VASc=3, and 1.1% CHA₂DS₂-VASc=4. This means that the 85.1% of the patients with a CHADS₂ score <2 and no contraindications are indicated for OAC.
Conclusions: The new recommendations will result in a significant increase in patients with indications for OAC, at the expense of those previously characterized as low-to-moderate risk. Therefore, patients at risk of thromboembolic events must be identified, although an evaluation of bleeding risk should be part of the patient assessment before starting anticoagulation.
Copyright © 2011 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.