Abstract

BACKGROUND: Efforts to improve oral anticoagulation (OAC) prescription in patients with atrial fibrillation (AF) have had limited success in improving guideline adherence.METHODS: We evaluated adherence to the ACC/AHA performance measures for OAC in eligible patients with a CHA2DS2-VASc=2 and trends in prescription over time in the American Heart Association's Get With The Guidelines (GWTG) AFIB registry. Adjusted associations with in-hospital outcomes were also determined. The cohort included 33,235 AF admissions with a CHA2DS2-VASc=2 enrolled at 115 sites between January 1, 2013 and September 31, 2017.RESULTS: The median age was 73 (65, 81), 52% were female, and the median CHA2DS2-VASc score was 4 (3, 5). At admission 16,206 (59.5%) with a prior diagnosis of AF were on OAC and OAC at admission was associated with a lower adjusted odds of in-hospital ischemic stroke (OR 0.38, 95% CI 0.24-0.59, p<0.0001). At discharge, prescription of OAC in eligible patients (no contraindications) was 93.5% (n=25,499/27,270). In a sensitivity analysis, when excluding only strict contraindications (4.6%, n=1,497/32,806), OAC prescription at discharge was 80.3%. Frequency of OAC was higher in those age =75, men, those with heart failure, prior AF ablation, and rhythm control (p<0.0001 for all). OAC use was lowest in Hispanic patients (90.2%, p<0.0001). Prescription of OAC at discharge in eligible patients improved over time from 79.9% to 96.6% (p<0.0001).CONCLUSIONS: Among hospitals participating in the GWTG-AFIB quality improvement program, OAC prescription at discharge in eligible guideline-indicated patients increased significantly and improved consistently over time. These data confirm that high-level adherence to guideline recommended stroke prevention is achievable.

View details for PubMedID 30700141