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Sex differences in stroke prevention in atrial fibrillation in French primary care. Results of the AFIGP (Atrial Fibrillation In General Practice) Database

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Abstract

Background and objectives

Most of the French patients diagnosed with atrial fibrillation (AF) are managed by general practitioners (GPs). The objective was to evaluate stroke prevention in AF patients ahead of the arrival of the non vitamin K oral anticoagulant in France.

Methods

A cross-sectional study using a French GPs database of all patients with a diagnosis of AF consulting their GP between July-2010 and June-2011. Multivariate analyses were used to identify determinants of prevention prescription.

Results

Among 15,623 AF patients, 42.5 % were ≥75 years and 40.5 % women, 59.2 % had hypertension, 17.2 % diabetes, 11.4 % heart failure, 4.9 % stroke history. CHADS2 score was ≥1 for 83.1 % and ≥2 for 50.9 % of patients (CHA2DS2-VASc score ≥1 for 93.7 % and ≥2 for 82.3 %). Antithrombotic therapies were vitamin K antagonists (VKA) for 50.7 % of patients, followed by aspirin for 19.9 %, clopidogrel ± aspirin for 4.3 % and none for 25.1 %. For patients with CHADS2 scores ≥1, 73.3 % received an antithrombotic and for those with CHADS2 scores ≥2, 54.9 % were treated by a VKA. An age-stratified multivariate analysis showed that women had an odds ratio to be treated with VKA compared to 0.83 (95 % CI: 0.72–0.95) and 0.66 (95 % CI: 0.59–0.74) when aged <75 years and ≥75 years, respectively.

Conclusions

Most AF patients followed by French GPs required stroke prevention according to European guidelines, but many of them did not receive the recommended antithrombotic treatment. Women over 75 were a third less likely to be treated with recommended anticoagulants than men of similar age.

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Acknowledgments

We are greatly indebted to Olivier Grenier (Hospital Pompidou, Paris, France) for helpful discussion. Funding for this study was provided by Bristol-Myers-Squibb and Pfizer, manufacturers of apixaban.

Conflict of interest

PS and PB have undertaken consultancy for the present study. LDB, FEC, PM and NB are employees of Bristol-Myers-Squibb, manufacturer of apixaban.

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Authors and Affiliations

  1. Department of Cardiology, Pitié Salpétrière Hospital, Heart Institute, Pierre and Marie Curie University, Paris, France

    Pierre Sabouret

  2. Bristol-Myers Squibb, Paris, France

    Leyla Depret-Bixio, François-Emery Cotte, Pierre Marie & Nabil Bedira

  3. Department of Pharmacology, University de Bordeaux, CHU de Bordeaux, Bordeaux, France

    Patrick Blin

  4. CIC Bordeaux CIC1401 INSERM, Bordeaux, France

    Patrick Blin

  5. Institute of Cardiology, Hospital Pitié-Salpetrière, 47-83, boulevard de l’Hôpital, 75013, Paris, France

    Pierre Sabouret

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  1. Pierre Sabouret
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Correspondence to Pierre Sabouret.

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Sabouret, P., Depret-Bixio, L., Cotte, FE. et al. Sex differences in stroke prevention in atrial fibrillation in French primary care. Results of the AFIGP (Atrial Fibrillation In General Practice) Database. Clin Res Cardiol 103, 887–893 (2014). https://doi.org/10.1007/s00392-014-0726-y

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  • DOI: https://doi.org/10.1007/s00392-014-0726-y

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