Oral Anticoagulation in Heart Failure with Atrial Fibrillation: Are We Taking the Right Steps Towards Guidelines?

Abstract

Background Atrial fibrillation (AF) is commonly coexists with heart failure (HF) and it contributes to higher morbidity and mortality. Many studies from developed countries disclosed underuse of OAC in this population despite robust guidelines recommendations. However, there is limited data from middle eastern countries regarding this issue. So, this study sought to investigate adherence rate of physicians to ACC guidelines regarding prescribing OAC for HF patients with non-valvular AF. Methods Patients who were presented to the hospital with HF and AF were included, patientsꞌ data collected including demographics, lab results and treatment during hospitalization and at discharge. So, patients grouped into: those who were prescribed OAC versus those who were not.CHA2DS2-VASc score was calculated by the investigator for each patient. Results Ninety-one cases with HF and AF were collected, three patients with prosthetic valves were excluded. Total (88) cases were recruited with mean age of 65.4±12.9 years, females constitute 42.04% of patients. Eighty-four patients (95.45%) meet ACC class I recommendation for OAC in HF with AF (CHA2DS2-VASc ≥2) while OAC was prescribed in 25 (29.76%) of them despite no contraindications in those who were not prescribed OAC. Among total (88) patients OAC was prescribed in 27 (30.68%) patients, among whom 37.03% were prescribed direct OAC. Among OAC group, 40.74% were females versus 42.62% in Non OAC group (p˂0.001), mean age was 64.5±13.4 in OAC group versus 65.8±12.8 (p=0.6), patients in OAC group were less to be hypertensive 74.07% versus 80.32% in Non OAC group (p˂0.001) and less to have IHD 55.5% versus 72.13% (p Conclusions OAC in context of HF with AF are underutilized in practice, they were less used in females, patients with hypertension, IHD and concomitant antiplatelets while used more in patients with diabetes and stroke. Every effort should be done to bridge this practice gap by implementing quality improvement projects to improve adherence to evidence-based therapy to achieve better cardiovascular care and outcomes