Key result
Only ~45% of chronic AF outpatients receive guideline-adherent antithrombotics, strongly linked to coumarin contraindications.
Why the study?
The study aimed to determine the prevalence of physician adherence to antithrombotic guidelines in outpatients with chronic AF and identify risk factors for nonadherence.
What are the predictors of guideline-nonadherence with antithrombotic therapy in outpatients with chronic atrial fibrillation?
Cross-Sectional (n=413)
Yes
What are the predictors of guideline-nonadherence with antithrombotic therapy in outpatients with chronic atrial fibrillation?
Less than half of outpatients with chronic AF receive guideline-adherent antithrombotic therapy, with absolute contraindications to coumarins being a major predictor of nonadherence.
Suboptimal antithrombotic adherence in chronic AF outpatients signals need for better contraindication management; leaves open whether improved adherence reduces stroke risk.
Purpose: Our aims were to determine the prevalence of physicians’ adherence to antithrombotic guidelines in the management of outpatients with chronic atrial fibrillation (AF) and to identify risk factors for nonadherence to treatment guidelines. Methods: Data on drug treatment, stroke risk factors and psychosocial variables were analyzed descriptively in a cross-sectional communitybased multicentre study. Predictors for nonadherence with guidelines for antithrombotic prophylaxis of AF patients were identified using logistic regression. Results: Of 413 outpatients with chronic AF attending the offices of family physicians, 184 (44.6%) were treated according to the American College of Chest Physicians (ACCP) 2001 guidelines. In the group of patients with a high risk of stroke (n=387), 178 patients (46.0%) received guideline-adherent treatment. 31 of the high-risk patients received coumarin although they had at least one contraindication. Multivariate analysis showed the presence of absolute contraindications to coumarins to be an independent predictor of guidelinenonadherent treatment. Conclusion: To improve guideline-adherence in the antithrombotic treatment in AF outpatients, strategies involving individual assessment of the risks and benefits will need to be established and implemented.
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Bücheler et al. (2021) conducted a cross-sectional in Chronic atrial fibrillation (n=413). Antithrombotic therapy was evaluated on Compatibility of antithrombotic treatment with ACCP 2001 recommendations. Only 44.6% of outpatients with chronic atrial fibrillation received guideline-adherent antithrombotic therapy, with absolute contraindications to coumarins strongly predicting nonadherence (RR 51.73).
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