Abstract
Background: Atrial fibrillation is a major health problem due to the stroke risk associated with it. To reduce stroke risk, oral anticoagulants (OAC) are prescribed using the CHA2DS2-VASc (Congestive heart failure; Hypertension; Age ≥75 years; Diabetes Mellitus; Stroke; Vascular disease; Age 65–74 years; Sex category) risk score, a clinical probability assessment that includes a combination of risk factors predicting the probability of a stroke. Not all patients with high risk are receiving this treatment. The aim of this study was to assess physician adherence to clinical guidelines concerning the OAC treatment and to identify the factors that were associated with the decision to prescribe it. Methods: Registry data from 784 patients with non-valvular atrial fibrillation were evaluated in this retrospective cross-sectional study. Demographic data, subtype of AF, comorbidities associated with higher stroke and bleeding risk, and antithrombotic treatment received were recorded. We compared stroke and bleeding risk in patients with and without OAC treatment to determine if the clinicians followed guidelines: prescribed when necessary and abstained when not needed. Results: OAC treatment was administered in 617 (78.7%) patients. Of the 167 patients who did not receive OAC, 161 (96.4%) were undertreated according to their risk score, as opposed to those who received OAC in which the percentage of overtreated was 3.2%. Most undertreated patients (60.5%, p < 0.001) were with paroxysmal atrial fibrillation subtype. Conclusions: The decision to use anticoagulants for stroke prevention was based on the type of atrial fibrillation, rather than on the risk of stroke as quantified by CHA2DS2-VASc as per the recommended guidelines.
Highlights
Atrial fibrillation (AF) patients are four to five times more at risk of stroke than the general population and have a doubled mortality rate [1]
The aim of this study is to evaluate whether, in a regional hospital, oral anticoagulants (OAC) is prescribed to “high risk” stroke patients, whether antiplatelets are overused in patients, and to assess overall adherence to clinical guidelines concerning OAC treatment in AF
All of the variables included in this study—namely congestive heart failure, hypertension, diabetes mellitus, previous stroke/transient ischemic attack (TIC) and vascular disease for the CHA2 DS2- VASc score; and liver disease
Summary
Atrial fibrillation (AF) patients are four to five times more at risk of stroke than the general population and have a doubled mortality rate [1]. If the patient is correctly prescribed an oral anticoagulant (OAC) and the risk factors are effectively controlled, the risk for stroke decreases substantially and the patient lives longer [2] In this regard, there is a broad consensus among international guidelines [2,3,4] for AF antithrombotic treatment toward the use of CHA2 DS2 -VASc. Age 65–74 years; Sex category) score to assess stroke risk, considering the variables that have been shown to increase stroke risk, and validated in a large population. Oral anticoagulants (OAC) are prescribed using the CHA2 DS2 -VASc (Congestive heart failure; Hypertension; Age ≥75 years; Diabetes Mellitus; Stroke; Vascular disease; Age 65–74 years; Sex category) risk score, a clinical probability assessment that includes a combination of risk factors predicting the probability of a stroke. The aim of this study was to assess physician adherence to clinical guidelines concerning the OAC treatment and to identify the factors that were associated with the decision to prescribe it
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