Adherence to the Canadian Cardiovascular Society Atrial Fibrillation Guidelines by Family Medicine Groups in Quebec: the I-FACILITER project

Abstract

Background: The Canadian Cardiovascular Society (CCS) Atrial Fibrillation (AF) guidelines 2014 recommends oral anticoagulation (OAC) for patients with CHADS2 ?1 or age ?65 years and non-vitamin K oral anticoagulants (NOAC)s as the preferred medications. We aimed to evaluate adherence to these guidelines by family group practices (FMG) in Quebec. Methods and results: We completed a cross-sectional evaluation at 15 FMGs. There were 431 patients with non-valvular AF: mean age of 77.3±10.4 years and 52.9% were females. CHADS2 and HAS-BLED were infrequently documented (47% and 7%, respectively). Most patients (93%) were appropriately anticoagulated (96% for both patients with CHADS2 ?1 and patients with age ?65 years). Sixty-five percent of patients were anticoagulated with warfarin, 28% with NOACs and 21% of patients received a combination of oral anticoagulant (OAC)s and aspirin. Every decade increase in age was associated with 49% increase in odds of adherence to the guidelines and 26% decrease in odds of NOACs’s use. Each point increase in HAS-BLED was associated with 51% decrease in odds of adherence to the guidelines and 36% decrease in odds of NOACS’s use. No patient with HAS-BLED of ?5 received NOAC. Heart failure was associated with a 61% decrease in odds of NOACS’s use. Conclusion: AF management by FMGs could be improved by 1) increasing NOACs uptake, 2) decreasing the combination of OAC with ASA and 3) increasing documentation of stroke and bleeding risks.