Abstract
To evaluate the level of agreement between cardiologists regarding the management of oral anticoagulation (OAC) in patients with non-valvular atrial fibrillation (NVAF) in Spain. A two-round Delphi study was performed using an online survey. In round 1, panel members rated their level of agreement with the questionnaire items on a 9-point Likert scale. Item selection was based on acceptance by ≥66.6% of panellists and the agreement of the scientific committee. In round 2, the same panellists evaluated those items that did not meet consensus in round 1. A total of 238 experts participated in round 1; of these, 217 completed the round 2 survey. In round 1, 111 items from 4 dimensions (Thromboembolic and bleeding risk evaluation for treatment decision-making: 18 items; Choice of OAC: 39 items; OAC in specific cardiology situations: 12 items; Patient participation and education: 42 items) were evaluated. Consensus was reached for 92 items (83%). Over 80% of the experts agreed with the use of DOACs as the initial anticoagulant treatment when OAC is indicated. Panellists recommended the use of DOACs in patients at high risk of thromboembolic complications (CHA2DS2-VASc ≥3) (83%), haemorrhages (HAS-BLED ≥3) (89%) and poor quality of anticoagulation control (SAMe-TT2R2 >2) (76%), patients who fail to achieve an optimal therapeutic range after 3 months on VKA treatment (93%), and those who are to undergo cardioversion (80%). Panellists agreed that the efficacy and safety profile of each DOAC (98%), the availability of a specific reversal agent (72%) and patient's preference (85%) should be considered when prescribing a DOAC. A total of 97 items were ultimately accepted after round 2. This Delphi panel study provides expert-based recommendations that may offer guidance on clinical decision-making for the management of OAC in NVAF. The importance of patient education and involvement has been highlighted.
Highlights
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, occurring in approximately 2% of the general population [1]
Panellists recommended the use of Direct-acting oral anticoagulants (DOACs) in patients at high risk of thromboembolic complications (CHA2DS2-VASc 3) (83%), haemorrhages (HAS-BLED 3) (89%) and poor quality of anticoagulation control (SAMe-TT2R2 >2) (76%), patients who fail to achieve an optimal therapeutic range after 3 months on Vitamin K antagonists (VKAs) treatment (93%), and those who are to undergo cardioversion (80%)
Panellists agreed that the efficacy and safety profile of each DOAC
Summary
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, occurring in approximately 2% of the general population [1]. Its prevalence is strongly associated with age [2], affecting 4.4% of adults over 40 years of age and 17.7% of patients aged 80 or older in Spain [3]. AF is a leading cause of increased morbidity and mortality from ischemic stroke and systemic thromboembolism [4]. AF is associated with a fivefold increase in the risk of thromboembolic stroke [5]. Decreasing the risk of stroke is essential in the clinical management of AF patients. Anticoagulant therapy represents the mainstay for the prevention of stroke and systemic embolism in patients with AF [6, 7]
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