Identification, risk assessment, and management of patients with atrial fibrillation in a large primary care cohort.

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dc.contributor.author Poppe, Katrina en
dc.contributor.author Doughty, Robert en
dc.contributor.author Harwood, Matire en
dc.contributor.author Barber, Peter en
dc.contributor.author Harrison, Jeffrey en
dc.contributor.author Jackson, Rodney en
dc.contributor.author Wells, Linda en
dc.date.accessioned 2018-12-10T00:03:54Z en
dc.date.issued 2018-03 en
dc.identifier.issn 1874-1754 en
dc.identifier.uri http://hdl.handle.net/2292/44940 en
dc.description.abstract Atrial fibrillation (AF) is associated with increased risk of cardiovascular disease (CVD) complications including stroke. We investigated the assessment and management of cardiovascular risk among patients with AF aged 35-74years, by ethnic group, in a large cohort of people receiving a CVD risk assessment in primary care (PREDICT).PREDICT was linked to national dispensing, hospitalisation and mortality records. AF was present if recorded in PREDICT or during a prior hospitalisation; medications were those dispensed ≤6months before or after a PREDICT assessment; the CHA2DS2-VASc score and a New Zealand (NZ) adjusted Framingham CVD risk were calculated. Data were linked to outcomes of stroke or major adverse cardiovascular event (MACE).12,739 (2.8%) of 447,020 people aged 35-74years had AF. Māori, the indigenous population of NZ, had the highest proportion of AF, which by age group, was similar to that among Europeans 10years older. 77% were at high stroke risk, of whom 42% received anticoagulation; 54% were at high CVD risk, of whom 67% received both lipid- and blood pressure-lowering medication. Per category of predicted risk, stroke risk was overestimated and risk of MACE was underestimated.The burden of AF and risk factors differed by ethnic group thus recommendations to screen for AF above a universal age threshold may introduce inequity in the detection and management of associated risk. The high burden of comorbidities at younger ages among many ethnic groups contributes to the poor performance of available risk assessment tools, further compounding potential inequity. en
dc.format.medium Print-Electronic en
dc.language eng en
dc.relation.ispartofseries International journal of cardiology en
dc.rights Items in ResearchSpace are protected by copyright, with all rights reserved, unless otherwise indicated. Previously published items are made available in accordance with the copyright policy of the publisher. en
dc.rights.uri https://researchspace.auckland.ac.nz/docs/uoa-docs/rights.htm en
dc.subject Humans en
dc.subject Atrial Fibrillation en
dc.subject Anticoagulants en
dc.subject Risk Assessment en
dc.subject Cohort Studies en
dc.subject Adult en
dc.subject Aged en
dc.subject Middle Aged en
dc.subject Ethnic Groups en
dc.subject Primary Health Care en
dc.subject Disease Management en
dc.subject Female en
dc.subject Male en
dc.subject Hypolipidemic Agents en
dc.title Identification, risk assessment, and management of patients with atrial fibrillation in a large primary care cohort. en
dc.type Journal Article en
dc.identifier.doi 10.1016/j.ijcard.2017.11.045 en
pubs.begin-page 119 en
pubs.volume 254 en
dc.rights.holder Copyright: The author en
dc.identifier.pmid 29407079 en
pubs.end-page 124 en
pubs.publication-status Published en
dc.rights.accessrights http://purl.org/eprint/accessRights/RestrictedAccess en
pubs.subtype Research Support, Non-U.S. Gov't en
pubs.subtype Journal Article en
pubs.elements-id 723996 en
pubs.org-id Medical and Health Sciences en
pubs.org-id Pharmacy en
pubs.org-id Population Health en
pubs.org-id Epidemiology & Biostatistics en
pubs.org-id Gen.Practice& Primary Hlthcare en
pubs.org-id School of Medicine en
pubs.org-id Medicine Department en
dc.identifier.eissn 1874-1754 en
pubs.record-created-at-source-date 2018-02-07 en
pubs.dimensions-id 29407079 en


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