222 Improving Atrial Fibrillation Management: Does It Reduce Stroke Burden? A Single Centre Audit Loop

Abstract

Atrial fibrillation contributes to 30% of stroke presentations, however many of these patients have known atrial fibrillation and should be on anti-coagulant treatment. In 2018, our audit identified that clinician oversight and incorrect oral anti-coagulation dosing was contributing to 10% of ischaemic strokes in our health district. To determine whether implementing changes to improve in hospital atrial fibrillation management, reduces incidence of atrial fibrillation-related strokes. A review was performed using electronic medical records of patients coded with acute ischaemic stroke admitted to Gosford Hospital between June 2018 and March 2020. These records were assessed for background of AF or newly diagnosed AF, anti-coagulant dose and if not prescribed, the rationale. Each patient had their CHA2DS2VASC score calculated. Using the patient’s age, weight and creatinine clearance or INR, anti-coagulant was marked as either under-, correctly, or over-dosed. 642 patients presented with ischaemic stroke. Average age was 74 years old and 54% were male. 438 had no AF, 204 had AF (160 known, 44 newly diagnosed) with average CHA2DS2VASC 3.96. Of 160 with known AF, 93 were taking anti-coagulation: 73 were taking DOACs (12 were incorrectly dosed) and 20 taking warfarin (11 sub-therapeutic). 67 patients were not anti-coagulated: 40% due to clinician oversight. Of the 93 patients on anti-coagulants pre-index admission, 23 (25%) of patients were either incorrectly dosed or, if taking warfarin, had a sub-therapeutic INR at admission. This is an improvement from the last audit where 40% were incorrectly dosed. Fewer preventable strokes occurred at the end of the audit cycle (7.8% vs 10% initially).