Presentation of atrial fibrillation and its management by cardiologists in the ambulatory and hospital setting: MOVE cross-sectional study

Abstract Objective: The aim of the study was to collect comprehensive data on atrial fibrillation (AF) in ambulatory and hospital-based management in Germany. Methods: Consecutive patients with ECG-confirmed AF in the previous 12 months were documented in a non-interventional study in 638 physician offices (78.0) or hospitals (12.7). Results: Of the 3354 patients (mean age 68.9 +/- 10.1 years; CHADS(2) score 1.9 +/- 1.3), a total of 1136 (33.9) had paroxysmal, 899 (26.8) persistent, 1295 (38.6) permanent and 24 (0.7) unspecified AF. In the 12 months prior to documentation, pharmacological conversion was attempted in 18.2, electric cardioversion in 17.5, the combination of both in 31.2, and catheter ablation of AF in 5.5. Only 41.4 of patients met the definition of stable disease (having neither AF related intervention nor change in antiarrhythmic therapy in the previous 12 months). As treatment strategy, physicians stated rate control in 64, rhythm control in 8, and both in 19 (not reported: 8). Patients received antiarrhythmic drugs of class IA in 1.3, IC in 13.8, II in 78.1, III in 17.9, IV in 9.7 and digitalis in 26.7. Drugs for thromboembolic prevention (oral anticoagulants and/or antithrombotics) were administered in 81.5. Hospitalisations for AF or associated diseases in the previous 12 months were reported in 34.2. Possible limitations include the open, observational design, selection of physicians with particular interest in the field and selection of patients (i.e. underrepresentation of critically ill individuals). Conclusions: While treatment rates with regards to the prevention of thromboembolic events were among the highest reported to date, the low proportion of stable patients and in particular, the high hospitalisation rate hint at difficulties in the management of patients with AF in clinical practice.