Evaluation of Adherence to Guideline-Directed Antithrombotic Therapy for Atrial Fibrillation at Hospital Discharge

Autor: Carmen Smotherman, Marci DeLosSantos, Lori Dupree
Rok vydání: 2018
Předmět:
Adult
Male
medicine.medical_specialty
Clinical Decision-Making
Hemorrhage
030204 cardiovascular system & hematology
Risk Assessment
Young Adult
03 medical and health sciences
0302 clinical medicine
Fibrinolytic Agents
Risk Factors
Atrial Fibrillation
Antithrombotic
medicine
Humans
Pharmacology (medical)
030212 general & internal medicine
Practice Patterns
Physicians'
Intensive care medicine
Stroke
Aged
Retrospective Studies
Aged
80 and over
Pharmacology
business.industry
Anticoagulants
Atrial fibrillation
Retrospective cohort study
Guideline
Middle Aged
medicine.disease
Patient Discharge
Practice Guidelines as Topic
CHA2DS2–VASc score
Platelet aggregation inhibitor
Accidental Falls
Female
Guideline Adherence
Cardiology and Cardiovascular Medicine
business
Platelet Aggregation Inhibitors
Fibrinolytic agent
Zdroj: Journal of Cardiovascular Pharmacology and Therapeutics. 23:502-508
ISSN: 1940-4034
1074-2484
DOI: 10.1177/1074248418778804
Popis: Background: Risk stratification for stroke in patients with atrial fibrillation is a vital step in identifying whether antithrombotic therapy is indicated for stroke prevention in this common arrhythmia. Purpose: The aim of this study was to determine adherence to guideline-directed antithrombotic therapy based on Congestive Heart Failure (1 point), Hypertension (1 point), Age (≥75 years old is 2 points and 65-74 is 1 point), Diabetes (1 point), prior Stroke (2 points), Vascular Disease (1 point), and Sex Category (1 point if female; CHA2DS2–VASc) score in patients with atrial fibrillation (AF) on hospital discharge. Methods: A total of 293 patients discharged from this academic medical center with a history of atrial fibrillation from June 2014 to June 2016 were enrolled. Demographic data and indicators for antithrombotic therapy based on the CHA2DS2–VASc score were recorded, and factors that affected adherence to guideline-directed therapy, such as bleeding risk, falls, and alcohol abuse, were collected and analyzed. Results: At hospital discharge, 63% of patients with AF were on appropriate antithrombotic therapy, 50% with a CHA2DS2–VASc score ≥2. The odds ratio of appropriate therapy in patients with a CHA2DS2–VASc score ≥2 was 1.17 (95% confidence interval [CI]: 0.95-1.30; P = .18). When chart documentation for reasons to withhold anticoagulation was considered as appropriate therapy, 81% of patients with AF were discharged on appropriate antithrombotic therapy with an odds ratio of 1.57 (95% CI: 1.26 -1.96, P < .0001), with bleeding and falls risk as the most common reasons to withhold anticoagulation. Conclusion: Based on risk stratification of stroke through the CHA2DS2–VASc score, the majority of patients with AF were discharged from the hospital on appropriate antithrombotic therapy. Withholding anticoagulation due to falls risk should be reconsidered as a result of the known benefits of stroke prevention in atrial fibrillation.
Databáze: OpenAIRE
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