RATIONALE AND DESIGN OF THE PROGRAM FOR THE IDENTIFICATION OF “ACTIONABLE” ATRIAL FIBRILLATION (PIAAF): SYSTEMATIC IDENTIFICATION TO DETECT PREVIOUSLY UNDIAGNOSED OR UNTREATED AF IN THE COMMUNITY

Abstract

strated that AF detected on cardiac implanted electronic devices (CIED) predicts a higher risk of stroke. Here we describe the results of a physician alert system for anticoagulation for AF detected on CIED. METHODS: Starting in 2013, the nurse-led pacemaker clinic at St Boniface Hospital implemented a physician alert system notifying referring physicians to the presence of AF on a CIED, and to suggest initiation of anticoagulation if CHADS2 > 1 and no contraindications. We reviewed patients who had these alerts from March 2013 to January 2014 using the pacemaker database and the St Boniface Hospital charts for demographics, stroke (CHADS2 and CHA2DS2VaSc) and bleeding (HASBLED) risk profile. We also reviewed the Manitoba Drug Program Information Network (DPIN) for prescription information regarding anticoagulation. Univariate and multivariate analysis were used to determine if risk factors were predictive of anticoagulation prescription. RESULTS: There were a total of 177 patients who had AF detected and alert produced, of which 126 had a CHADS2 > 1 (71%.) There were 72 males (57%) with a mean age of 82 9. Overall prevalence of risk factors for thromboembolism are listed in table 1. Overall 52 patients (41%) were started on anticoagulation (18 on vitamin K antagonist and 34 on non vitamin K antagonist) with the majority (39/52, 75%) started in the first 3 months. Overall there was no noticeable difference in the rates of anticoagulation for those with thromboembolism risk factors and those without (table 1) as well as for bleeding risk factors, except for prescription for ASA. On multivariate analysis, only being on ASA (OR 0.20 (0.08 0.46), and AF episodes lasting > 4 hours (OR 2.85 (1.07 7.56), p 1⁄4 0.035) were predictive of anticoagulation. CONCLUSION: In this analysis of a physician alert system for anticoagulation for patients with AF diagnosed on CIED, 41% of patients for whom alerts were produced were started on anticoagulation. There remains significant room for education with regards to anticoagulation for care providers of patients with CIED and AF. 456 RATIONALE AND DESIGN OF THE PROGRAM FOR THE IDENTIFICATION OF “ACTIONABLE” ATRIAL FIBRILLATION (PIAAF): SYSTEMATIC IDENTIFICATION TO DETECT PREVIOUSLY UNDIAGNOSED OR UNTREATED AF IN THE COMMUNITY