The doctor, his patient and Balint

Abstract

Atrial fibrillation (AF) is the most widespread cardiac arrhythmia in Family Medicine, affecting 1-2% of the general population and 5% of the population over 65 years old. Patients with this type of cardiac arrhythmia have a greater risk of death and morbidity, namely due to cerebral hemorrhage.This article seeks to reflect on the international recommendations regarding AF therapy and the family physicians practice, mostly pertaining to anticoagulation. Therefore, we present two clinical cases of patients with AF. In both situations, the cases consisted of first-time consultations with the author during which the suitability of the prescribed therapeutics was evaluated and adjustments were made to the AF therapeutics.We expose some literature data that were used to fundament the decisions made regarding these two patients. According to international norms, the control of the heart rate associated with chronic anti-coagulation is the most diffused strategy relating to patients with AF.When heart rate control is intended, the drugs that stand first in line are beta-blockers and calcium-channel blockers. Finally, due to the fact that oral anticoagulation is not a risk-exempted therapeutics, there are scales that establish group-risks for thromboembolic events.These scales may help in the decision-making process related with antithrombotic therapeutics. Additionally, we reflect on the significance of the international recommendations regarding the specificity of Family Medicine. As a provider of comprehensive and long-term health-care, the family physician stands on an optimum advantage point to judge if the AF therapeutics achieves the best possible results throughout several years of treatment. On the other hand, knowing the patient and his context, the physician can prompt the family into maintaining control over a therapeutic that demands a tight watch.