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Patients Can Self-Treat Atrial Fibrillation

ER visits, hospital visits down by 90%, study finds

WEDNESDAY, Dec. 1, 2004 (HealthDayNews) -- A "pill-in-the-pocket" self-treatment program can reduce emergency room visits and hospitalizations by nearly 90 percent for people with the heartbeat abnormality called atrial fibrillation, a new study says.

Patients with mild atrial fibrillation and no complicating conditions were trained to take a drug to restore normal heart function when they felt the first symptoms of an attack. For the 210 people in the study, emergency room visits dropped from an average of 45.6 a month in the year before self-treatment began to 4.9 per month, while the number of hospitalizations dropped from an average of 15 a month to 1.6 a month.

Italian researchers report their results in the Dec. 2 issue of the New England Journal of Medicine.

The self-treatment method is being used increasingly in the United States, said Dr. Kenneth A. Ellenbogen, a professor of medicine at Virginia Commonwealth University and a spokesman for the American Heart Association. Because of the large number of conditions that preclude its use, only 10 percent to 20 percent of people with atrial fibrillation are eligible for it, but the benefits for them are "quite striking," he said.

"This is a very large study that for the first time gets a handle on how this approach can be used to treat patients with atrial fibrillation," he said.

An estimated 2.2 million Americans are affected by atrial fibrillation, in which the upper chambers of the heart periodically experience an abnormal rhythm that reduces their ability to pump blood, and the number is growing by 150,000 to 200,000 a year as the population ages, said Dr. A. Marc Gillinov, surgical director of the atrial fibrillation program at the Cleveland Clinic Heart Center.

"It is such a huge and pervasive problem that using it on 10 to 20 percent of them can have a huge impact," Gillinov said.

The 210 people in the Italian study were just 12 percent of those initially considered for inclusion; the others were excluded for a variety of accompanying conditions. Those who entered the study were prescribed either flecainide or propafenone, two drugs commonly used in hospital treatment of atrial fibrillation. They were told to take a pill when they felt an episode coming on.

A total of 618 episodes of atrial fibrillation were reported by 165 patients in the study. Of those, 569 were treated by the patients, with a success rate of 94 percent.

"The most important finding of the study is that self-treatment was safe," Gillinov said. Only 12 participants reported adverse effects during one or more episodes of atrial fibrillation, the report said.

The choice between the two drugs is not important, since both are equally effective, Ellenbogen said.

Successful self-treatment is a boon to both the health-care system and patients, Gillinov said. Keeping people out of the hospital saves money, he said, and "no one likes to sit in the emergency room, waiting."

More information

Get the facts on atrial fibrillation and its treatment from the American Heart Association.

SOURCES: Kenneth A. Ellenbogen, M.D., professor, medicine, Virginia Commonwealth University, Richmond; A. Marc Gillinov, M.D., surgical director, atrial fibrillation program, Cleveland Clinic Heart Center; Dec. 2, 2004, New England Journal of Medicine
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