Adherence to Guideline-Directed Stroke Prevention Therapy for Atrial Fibrillation Is Achievable: First Results From Get With The Guidelines–Atrial Fibrillation (GWTG-AFIB). Issue 12 (19th March 2019)

• Record Type: Journal Article
• Authors: Piccini, Jonathan P.; Xu, Haolin; Cox, Margueritte; Matsouaka, Roland A.; Fonarow, Gregg C.; Butler, Javed; Curtis, Anne B.; Desai, Nihar; Fang, Margaret; McCabe, Pamela J.; Page II, Robert L.; Turakhia, Mintu; Russo, Andrea M.; Knight, Bradley P.; Sidhu, Mandeep; Hurwitz, Jodie L.; Ellenbogen, Kenneth A.; Lewis, William R.
• Is Part Of: Circulation. Volume 139:Issue 12(2019)
• Publication Date: 2019-03-19
• Subjects: atrial fibrillation -- guideline adherence -- outcomes -- measures; Blood -- Circulation -- Periodicals; Cardiovascular system -- Periodicals; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; Blood Circulation; Cardiovascular System; Vascular Diseases; 616.1
• DOI: 10.1161/CIRCULATIONAHA.118.035909
• Languages: English
• ISSNs: 0009-7322

Abstract

Abstract : Background: Efforts to improve prescription of oral anticoagulation (OAC) drugs in patients with atrial fibrillation have had limited success in improving guideline adherence. Methods: We evaluated adherence to the American College of Cardiology/American Heart Association performance measures for OAC in eligible patients with a CHA2 DS2 -VASc score ≥2 and trends in prescription over time in the American Heart Association's Get With The Guidelines–AFIB (atrial fibrillation) registry. Adjusted associations with in-hospital outcomes were also determined. The cohort included 33 235 patients with a CHA2 DS2 -VASc score ≥2 who were admitted for atrial fibrillation and were enrolled at 115 sites between January 1, 2013, and September 31, 2017. Results: The median (25th, 75th percentile) age was 73 years (65, 81 years); 51% were female; and the median (25th, 75th percentile) CHA2 DS2 -VASc score was 4 (3, 5). At admission, 16 206 (59.5%) of 27 221 patients with a previous diagnosis of atrial fibrillation were taking OAC agents, and OAC drug use at admission was associated with a lower adjusted odds of in-hospital ischemic stroke (odds ratio, 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 of 27 270). In a sensitivity analysis, when excluding only strict contraindications (4.6%, n=1497 of 32 806), OAC prescription at discharge was 80.3%. OAC prescription at discharge was higher in those aged ⩽75 years, men, those with heart failure, those with previous atrial fibrillation ablation, and those with 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. Abstract : Supplemental Digital Content is available in the text.