Prescrição de terapêutica anticoagulante por médicos de Medicina Geral e Familiar e especialidades hospitalares, em utentes com Fibrilhação/Flutter auricular de quatro Unidades de Saúde Familiar

Abstract

Main purpose: To evaluate if the prescription of oral anticoagulants (OAC) varies significantly among the specialties responsible for the diagnosis of atrial fibrillation/auricular flutter (AF/AFL). Specific purposes: To evaluate if the specialty responsible for the diagnosis of AF/AFL is the specialty responsible for the prescription of OAC; to analyse the time elapsed between the diagnosis of AF/AFL and the prescription of OAC. Study: Observational, retrospective, and analytical. Place: Four Family Health Units (FHU). Target population: Users aged 18 years old or over, with a new-onset diagnosis of AF/AFL performed between 01/01/2010 and 31/12/2015. Material and methods: Identification of all users and collection of demographic and clinical variables of interest for the study. Multivariate logistic regression was performed in order to evaluate whether the prescription of OAC varies significantly among the specialties responsible for the diagnosis. The agreement between the specialty that diagnosed AF/AFL and the specialty that prescribed OAC was evaluated through the kappa concordance coefficient. The time elapsed between diagnosis and prescription corresponded to the period of time between the date of the first registration or coding of AF/AFL and the moment of the first prescription of OAC, in days. Results: 606 patients were included: 60.6% women, mean age 75.1 years. Amongst AF/AFL diagnoses, 45.7% were performed by general and family medicine specialists (GFM). There were no significant differences in the prescription of OAC between GFM and cardiology (OR=2.14; 95% CI 0.74-6.12, p=0.157) and internal medicine specialists (OR=0.67; 95%CI 0.40-1.11, p=0.123). The small number of cases of AF/AFL cases diagnosed by neurology did not allow any conclusive comparison between this specialty and FGM. There was good agreement between the specialty diagnosing AF/AFL and the one prescribing OAC (kappa=0.740 and p<0.001). The time elapsed between the diagnosis of AF/AFL and the start of OAC was significantly higher (p<0.001) in patients diagnosed by FGM specialists (median 15.0 days), compared to cardiology and internal medicine consultants (median 0.0 and 3.0 days, respectively). Conclusion: Contrarily to international studies, this study demonstrated that there is great agreement between the specialty responsible for the diagnosis of AF/AFL and the specialty that prescribes anticoagulation. Family doctors, however, take longer to prescribe anticoagulation. It will be important to establish strategies that allow FGM specialists to prescribe anticoagulation more timely, and if possible, at the time of diagnosis.