Ocena zgodności z wytycznymi leczenia stosowanego w ramach prewencji powikłań zakrzepowo-zatorowych u hospitalizowanych chorych z migotaniem przedsionków

Abstract

Introduction. Atrial fibrillation (AF) is the most common supraventricular arrhythmia. It results in an increased frequency of thromboembolic complications and a higher death rate. The frequency of arrhythmia is steadily increasing, and a sustained growth in the number of patients with AF can be expected in the coming years. Thromboembolic episodes are the most serious complications of AF. Anticoagulant treatment, based on recommendations, is considered to be the priority action in patients with AF. The aim of this paper is to evaluate compliance with guidelines for the prevention of thrombosis, recommended on discharge, in patients with non-valvular AF, who were hospitalised in a cardiology ward. Methods and materials. 4,099 patients with non-valvular AF, who had been hospitalised and discharged from a cardiology ward between 2004 and 2012, were subject to a retrospective analysis. We assessed the risk of thromboembolic (via CHADS 2 score) and haemorrhagic (via HAS-BLED score) complications, as well as data on comorbid conditions and the recommended anticoagulant prevention. The compliance of the prevention of thromboembolic complications with the guidelines was assessed according to the applied anticoagulant and antiplatelet treatment in particular groups of thromboembolism risk. Results. The average age of the examined group was 70.6 (± 10.9) years. AF co-existed most frequently with the following diseases: hypertension (74.8%), ischaemic heart disease (56.7%), and heart failure (54.8%). A low risk of thromboembolic complications was reported in 7.2% of patients, whereas 25.4% were rated as moderate risk, and 67.4% as high thromboembolic risk. A high risk of bleeding was reported in 34.6% of patients. In the prevention of thromboembolic complications, an oral anticoagulant, in monotherapy or in combination with antiplatelet drugs, was recommended for 64% of patients on discharge. According to the guidelines, 66.9% of patients from the examined group qualified for the prevention of thromboembolic complications: 62.4% of those with a high risk of stroke, 86% of those with a moderate risk, and 41.1% of those without stroke risk factors. The highest percentage of patients treated pursuant to the guidelines in the chosen clinical situations was to be seen among patients after a thromboembolic episode (70.8%). We found that in 73.8% of patients aged 65–74, and in 55.2% of patients over the age of 80, anticoagulant prevention was applied in accordance with the guidelines. Conclusions. On discharge from hospital, nearly two-thirds of patients with AF were subjected to the prevention of thromboembolic complications in accordance with the guidelines. Most often they belonged to the group of moderate risk, and least often to the group without thromboembolic risk factors. A high percentage of patients treated in line with the guidelines was seen in the patients who recovered from a thromboembolic episode. The percentage of patients with AF who were subjected to anticoagulant treatment in accordance with the guidelines decreased with age.