Fibrilación auricular: de la detección al tratamiento. Papel del médico de familia, del cardiólogo y de otros especialistas. Nuevos modelos de gestión clínica

The prevalence of atrial fibrillation (AF) in adults in Spain is estimated to be 4.4% of the population aged 40 years or more, corresponding to a mean of 30 to 40 patients per family physician. The importance of this common arrhythmia lies, above all, in its close association with stroke and other systemic embolisms, among other possible complications. Diagnosis of AF is based on electrocardiographic recording and can consequently be made by the family physician, who should make an overall assessment of the patient's health, including risk factors, comorbidity and type of AF and evaluate embolic and hemorrhagic risk. The decision to prescribe anticoagulation therapy or not should be taken promptly and should be based on the patient's embolic risk and not on the type of arrhythmia. In addition, the family physician, together with the treating cardiologist, should decide on the most appropriate therapeutic strategy for each individual patient: a rhythm control strategy (attempting to recover and maintain sinus rhythm) or a rate control strategy (maintaining heart rate within acceptable limits). Antithrombotic treatment should form part of both strategies, since stroke is the most serious and common complication of AF and also has the greatest effects on morbidity and mortality. Moreover, cardioembolic strokes (accounting for one out of every four strokes) are especially devastating, with the highest fatality, hospital and social resource use, and associated disability. Control of AF and particularly stroke prevention with adequate anticoagulation should be carried out mainly in primary care. Nevertheless, multidisciplinary management is required in most patients, which requires effective coordination between primary and specialized care, especially cardiology, hematology and neurology (in patients who have already had a stroke).