Oral anticoagulant therapy in adults with congenital heart disease and atrial arrhythmias

Autor: Martijn C. Post, A.P.J. van Dijk, B.J.M. Mulder, J.F. Heidendael, B.J. Bouma, T.C. Konings, M.M. Winter, Gerrit Veen, Folkert J. Meijboom, H. Yang, J. R. de Groot, G.Tj. Sieswerda
Přispěvatelé: Cardiology, ACS - Atherosclerosis & ischemic syndromes, ACS - Heart failure & arrhythmias, Amsterdam Cardiovascular Sciences, APH - Personalized Medicine, APH - Aging & Later Life, ACS - Pulmonary hypertension & thrombosis
Jazyk: angličtina
Rok vydání: 2018
Předmět:
Adult
Heart Defects
Congenital
Male
medicine.medical_specialty
Heart disease
Vascular damage Radboud Institute for Health Sciences [Radboudumc 16]
Administration
Oral
Hemorrhage
Guidelines
030204 cardiovascular system & hematology
Cohort Studies
Anticoagulation
03 medical and health sciences
0302 clinical medicine
All institutes and research themes of the Radboud University Medical Center
Risk Factors
Thromboembolism
Internal medicine
Atrial Fibrillation
medicine
Humans
Adult congenital heart disease
Prospective Studies
Registries
030212 general & internal medicine
Medical prescription
Aged
Atrial arrhythmias
business.industry
Anticoagulants
Atrial fibrillation
Evidence-based medicine
Guideline
Middle Aged
medicine.disease
GUCH
Implementation
Practice Guidelines as Topic
Oral anticoagulant
Female
Cardiology and Cardiovascular Medicine
business
Follow-Up Studies
Zdroj: International Journal of Cardiology, 257, 67-74. Elsevier Ireland Ltd
International Journal of Cardiology, 257, pp. 67-74
International Journal of Cardiology, 257, 67-74
International Journal of Cardiology, 257, 67. Elsevier Ireland Ltd
International journal of cardiology, 257, 67-74. Elsevier Ireland Ltd
Yang, H, Heidendael, J F, de Groot, J R, Konings, T C, Veen, G, van Dijk, A P J, Meijboom, F J, Sieswerda, G T, Post, M C, Winter, M M, Mulder, B J M & Bouma, B J 2018, ' Oral anticoagulant therapy in adults with congenital heart disease and atrial arrhythmias : Implementation of guidelines ', International Journal of Cardiology, vol. 257, pp. 67-74 . https://doi.org/10.1016/j.ijcard.2017.12.038
ISSN: 0167-5273
DOI: 10.1016/j.ijcard.2017.12.038
Popis: Background: Current guidelines on oral anticoagulation (OAC) in adults with congenital heart disease (ACHD) and atrial arrhythmias (AA) consist of heterogeneous and divergent recommendations with limited level of evidence, possibly leading to diverse OAC management and different outcomes. Therefore, we aimed to evaluate real-world implementation and outcome of three guidelines on OAC management in ACHD patients with AA. Methods: The ESC GUCH 2010, PACES/HRS 2014 and ESC atrial fibrillation (AF) 2016 guidelines were assessed for implementation. ACHD patients with recurrent or sustained non-valvular AA from 5 tertiary centers were identified using a national ACHD registry. After two years of prospective follow-up, thromboembolism, major bleeding and death were assessed. Results: In total, 225 adults (mean age 54 ± 15 years, 55% male) with various defects (simple 43%; moderate 37%; complex 20%) and AA were included. Following the most strict indication (OAC is recommended in all three guidelines), one should treat a mere 37% of ACHD patients with AA, whereas following the least strict indication (OAC is recommended in any one of the three guidelines), one should treat 98% of patients. The various guidelines were implemented in 54–80% of patients. From all recommendations, Fontan circulation, CHA2DS2-VASc ≥ 1 and AF were independently associated with OAC prescription. Superiority of any guideline in identifying outcome (n = 15) could not be demonstrated. Conclusions: The implementation of current guidelines on OAC management in ACHD patients with AA is low, probably due to substantial heterogeneity among guidelines. OAC prescription in daily practice was most consistent in patients with AF and CHA2DS2-VASc ≥ 1 or Fontan circulation.
Databáze: OpenAIRE
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