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Anticoagulation for Chronic Atrial Fibrillation

Scott Stern, MD; Diane Altkorn, MD; Wendy Levinson, MD
JAMA. 2000;283(22):2901-2903. doi:10.1001/jama.283.22.2901.
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Atrial fibrillation is a common condition and risk factor for stroke. At age 60 years, the prevalence of atrial fibrillation is 1%, increasing to 5% for patients aged 70 to 75 years and exceeding 10% in patients older than 80 years.1 The most common disease origins of atrial fibrillation are hypertensive heart disease and ischemic heart disease.

The rate of ischemic stroke in patients with atrial fibrillation is approximately 4.5% per year but varies widely depending on the patient's age and coexistent diseases.1 The stroke rate in patients without cardiovascular disease increases from 1.6% per year for patients in their 60s to 3% per year for patients older than 80 years.1 Clinical risk factors that affect the stroke rate include the presence of valvular heart disease, prior thromboembolism, hypertension, diabetes, congestive heart failure (CHF), and coronary artery disease.

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Figure. An Approach to Treating Atrial Fibrillation
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TIA indicates transient ischemic attack; CVA, cerebrovascular accident; CHF, congestive heart failure.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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