Evaluation of Guideline-Directed Medical Therapy for the Reduction of Stroke and Systemic Embolism in Hospitalized Patients with Nonvalvular Atrial Fibrillation. (February 2021)

• Record Type: Journal Article
• Authors: Tellor, Katie B.; Lloyd, Michael D.; Hartman, Timothy J.; Armbruster, Anastasia L.
• Is Part Of: Hospital pharmacy. Volume 56:Number 1(2021)
• Page Start: 26
• Page End: 31
• Publication Date: 2021-02
• Subjects: anticoagulation -- antithrombotic -- atrial fibrillation -- guideline -- stroke; Hospital pharmacies -- Periodicals; Pharmacy Service, Hospital; Hospital pharmacies; Periodicals; Periodicals; 615.1
• DOI: 10.1177/0018578719851721
• Languages: English
• ISSNs: 0018-5787

Abstract

Background: Guidelines recommend antithrombotic therapy in patients with nonvalvular atrial fibrillation (NVAF) to reduce the risk of stroke and systemic embolism (SSE) based on an assessment utilizing the CHA2 DS2 -VASc score. However, a treatment gap exists regarding patients at risk for thromboembolic events.Objectives: The aim of this study was to characterize the use of guideline-directed medical therapy (GDMT) to reduce the risk of SSE in patients with NVAF upon hospital discharge.Methods: This retrospective review evaluated patients admitted to a community hospital with NVAF in 2016. All patients were included except for the following: < 18 years of age, concomitant valvular heart disease, expired during hospitalization, or discharged on hospice care. Descriptive statistics were reported for all parameters.Results: A total of 2739 patients with NVAF were included with 59.9% discharged on GDMT to reduce the risk of SSE. A 1% increase in GDMT at discharge was observed in patients admitted with a history of NVAF (n = 2238; 60.1% vs 61.1%). Patients with first-detected NVAF (n = 501) were discharged on GDMT 54.5% of the time. In patients with a high stroke risk, concomitant heart failure ( P = .001) and a lower HAS-BLED score (mean = 2.85 vs 3.18; P < .0001) were associated with receiving GDMT upon discharge. However, patients with increased age (mean = 78.5 vs 76.4; P < .0001), vascular disease ( P = .02), prior major bleeding ( P < .0001), or first-detected NVAF ( P < .0001) were less likely to be discharged on GDMT.Conclusions: Consistent with published registry data, a gap was observed in the use of GDMT to reduce the risk of SSE in patients with NVAF at this institution. Further investigation into methods for improvement is warranted.