[Nonvalvular atrial fibrillation: thromboembolic risk assessment and therapy in a general practice population]. / Fibrillazione atriale non valvolare: valutazione del rischio tromboembolico e del trattamento antitrombotico in una popolazione di pazienti in medicina generale.

BACKGROUND: Cardiologists may prescribe antithrombotic therapy to patients with atrial fibrillation (AF), but prescription application mostly depends on general practitioners. The present study aims to assess frequency and appropriateness of antithrombotic therapy in general practice, as a function of thromboembolic risk factors, using the CHADS2 score. METHODS: The computer records of 39 general practitioners were evaluated in order to identify patients with non-valvular AF; therapy and thromboembolic risk factors were recorded. RESULTS: AF was documented in 951 patients; 96 (10.1%) had contraindications to oral anticoagulants. Among the remaining 850 patients, 292 (34.4%) did not receive antithrombotic therapy according to guidelines. In particular, 102 (12.0%) did not receive any antithrombotic treatment. CONCLUSIONS: Among general practitioners of the Veneto region (Italy), the application of guidelines on antithrombotic therapy in non-valvular AF is comparable, or even slightly better than that reported in published cohort studies, but it deserves further improvement. There is a need for targeted educational interventions and a better coordination between cardiologists and general practitioners.

Aldosterone to Renin ratio in a primary care setting: the Bussolengo study.

The aim of the study was to evaluate the prevalence of hypertension associated with an elevated aldosterone to renin activity ratio (ARR) in a sample of adults aged 35-74 yr, randomly selected from the population register of the Bussolengo Health District (northern Italy) and representative of the total population of the district. Subjects (n = 1462) were randomly selected from the population register and examined by their general practitioners. Complete data for 1348 individuals were available for final statistical analysis. Apart from verapamil or alpha-blockers, no hypotensive drugs were allowed during the 4 wk before assay. Direct active renin and aldosterone were measured in the plasma of hypertensive patients after 2 h in the upright posture. Of 412 identified hypertensive patients, 287 subjects agreed to give blood (70% response rate). An aldosterone to active renin ratio (AARR) of 32 pg/ml was taken as the cut-off value, equivalent to an ARR of 50 ng/dl/ng/ml.h. An elevated AARR was observed in 32.4% of the hypertensive patients, with increased prevalence in females and in people aged 55 yr or older. As an elevated AARR is frequent in the general hypertensive population, screening should not be limited to the patients referred to specialist units.