Abstract
Atrial fibrillation (AF) is the most common arrhythmia in clinical practice; its prevalence increases substantially with age, representing a growing epidemic with substantial effects on mortality and morbidity [1]. The more recent epidemiological data come from a large cross-sectional study in adults in California involving a population of 1.89 million [2]. The prevalence of AF was 0.95%, increasing from 0.1% among adults younger than 55 years to 9.0% in persons aged 80 years or older. The authors estimate that approximately 2.3 million adults in the USA currently have AF and project that this will increase to more than 5.6 million by the year 2050, with more than 50% of affected individuals aged 80 years or older. In Italy it is estimated that there are about 500,000 cases of AF at present, with 60,000 new cases per year.
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References
Tsang TSM, Gersh BJ (2002) Atrial fibrillation: an old disease, a new epidemic. Am J Med 113:432–435
Go AS, Hylek EM, Phillips KA et al (2001) Prevalence of diagnosed atrial fibrillation in adults. National implications for rhythm management and stroke prevention: the Anticoagulation and Risk Factors In Atrial Fibrillation (ATRIA) Study. JAMA 285:2370–2375
Blackshear JL, Kopecky SL, Litin SC, Safford RE, Hammil SC (1996) Management of atrial fibrillation in adults: prevention of thromboembolism and symptomatic treatment. Mayo Clin Proc 71:150–160
Page RL, Wilkinson WE, Clair WK, McCarthy EA, Pritchett EL (1994) Asymptomatic arrhythmias in patients with paroxysmal atrial fibrillation and paroxysmal supraventricular tachycardia. Circulation 89:224–227
Roche F, Gaspoz JM, Da Costa A et al (2002) Frequent and prolonged asymptomatic episodes of paroxysmal atrial fibrillation revealed by automatic long-term event recorders in patients with a negative 24-hour Holter. Pacing Clin Electrophysiol 25:1587–1593
Atrial Fibrillation Investigators (1994) Risk factors for stroke and efficacy of antithrombotic therapy in atrial fibrillation: analysis of pooled data from five randomized controlled trials. Arch Intern Med 154:1449–1457
Hart RG, Pearce LA, McBride R et al, on behalf of the Stroke Prevention in Atrial Fibrillation (SPAF) Investigators (1999) Factors associated with ischemic stroke during aspirin therapy in atrial fibrillation. Analysis of 2012 participants in the SPAF I-III clinical trials. Stroke 30:1223–1229
Di Pasquale G, Urbinati S, Pinelli G (1995) New echocardiographic markers of embolic risk in atrial fibrillation. Cerebrovasc Dis 5:315–322
Hart RG, Benavente O, McBride R, Pearce LA (1999) Antithrombotic therapy to prevent stroke in patients with atrial fibrillation: a meta-analysis. Ann Intern Med 131:492–501
Albers GW, Dalen JE, Laupacis A, Manning WJ, Petersen P, Singer DE (2001) Antithrombotic therapy in atrial fibrillation. Sixth ACCP Consensus Conference on Antithrombotic Therapy. Chest 119 [Suppl]:194S–206S
Fuster V, Ryden L et al (2001) ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation: executive summary. Am J Cardiol 38:1231–1265
Di Pasquale G, Cerè E, Biancoli S et al (2002) Antiplatelet agents for prevention of thromboembolism in atrial fibrillation: when, why, and which one? In: Raviele A (ed) Cardiac arrhythmias 2001. Springer-Verlag Italia, Milan, pp 422–435
Bungard TJ, Ghali WA, Teo KK, Mc Alister FA, Tsuyuki RT (2000) Why do patients with atrial fibrillation not receive warfarin? Arch Intern Med 160:41–46
Go AS, Hylek EM, Borowsky LH, Phillips KA, Selby JV, Singer DE (1999) Warfarin use among ambulatory patients with nonvalvular atrial fibrillation: the anticoagulation and risk factors in atrial fibrillation (ATRIA) study. Ann Intern Med 131: 927–934
Palareti G, Leali N, Coccheri S et al, on behalf of the Italian Study on Complications of Oral Anticoagulant Therapy (1996) Bleeding complications of oral anticoagulant treatment: an inception-cohort, prospective collaborative study (ISCOAT). Lancet 348:423–428
Landefeld CS, Goldman L (1989) Major bleeding in outpatients treated with warfarin. Incidence and prediction by factors known at the start of outpatient therapy. Am J Med 87:144–152
Palareti G, Hirsh J, Legnani C et al (2000) Oral anticoagulation treatment in the elderly: a nested prospective, case-control study. Arch Intern Med 160:470–478
Wehinger C, Stollberger C, Langer T, Schneider B, Finsterer J (2001) Evaluation of risk factors for stroke/embolism and of complications due to anticoagulant therapy in atrial fibrillation. Stroke 32:2246–2252
Palareti G, Poggi M, Guazzaloca G et al (1997) Assessment of mental ability in elderly anticoagulated patients: its reduction is associated with a less satisfactory quality of treatment. Blood Coagul Fibrinolysis 8:411–417
Ansell JE, Hughes R (1996) Evolving models of warfarin management: anticoagulation clinics, patient self-monitoring, and patient self-management. Am Heart J 132:1095–1100
Chiquette E, Amato MG, Bussey HI (1998) Comparison of an anticoagulation clinic with usual medical care: anticoagulation control, patient outcomes, and health care costs. Arch Intern Med 158:1641–1647
Fitmaurice DA, Hobbs FD, Delaney BC, Wilson S, McManus R ( 1998) Review of computerized decision support system for oral anticoagulation management. Br J Haematol 102:907–909
Manotti C, Moia M, Palareti G, Pengo V, Ria L, Dettori AG (2001) Effect of computeraided management on the quality of treatment in anticoagulated patients: a prospective, randomized, multicenter trial of APROAT (Automated Program for Oral Anticoagulated Treatment). Haematologica 86:1060–1070
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Di Pasquale, G., Ceré, E., Lombardi, A., Sassone, B., Biancoli, S., Vandelli, R. (2004). Warfarin Underuse for Nonvalvular Atrial Fibrillation: How to Adjust Our Aims?. In: Raviele, A. (eds) Cardiac Arrhythmias 2003. Springer, Milano. https://doi.org/10.1007/978-88-470-2137-2_32
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DOI: https://doi.org/10.1007/978-88-470-2137-2_32
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