Implementing hospital guidelines for antithrombotic therapy increased appropriate oral anticoagulant prescription at discharge by an absolute 25.3% in patients with non-valvular atrial fibrillation.
Observational (n=701)
No
Effect estimate: Absolute difference 25.3% (95% CI 14.9-34.9)
Absolute Event Rate: 81.9% vs 56.6%
BACKGROUND: The use of oral anticoagulant therapy (OAT) to prevent non-valvular atrial fibrillation (NVAF) related-strokes is often sub-optimal. We aimed to evaluate whether implementing guidelines on antithrombotic therapy (AT) by a multifaceted strategy may improve appropriateness of its prescription in NVAF-patients discharged from a large tertiary-care hospital. METHODS: A survey was conducted on all consecutive NVAF patients discharged before (1st January-30th June 2000, n = 313) and after (1st January-30th June 2004, n = 388) guideline development and implementation. RESULTS: When strongly recommended, OAT use increased from 56.6% (60/106 in 2000) to 81.9% (86/105 in 2004), with an absolute difference of +25.3% (95%CI: 15% 35%). In patients for whom the choice OAT/acetylsalicylic acid should be individualised, those discharged without any AT were 33.7% (34/101) in 2000 and 16.9% (21/124) in 2004 (-16.7%;95%CI: -26.2% -7.2%). In a logistic regression model, OAT prescription in 2004 was increased by 2.11 times (95%CI: 1.47 3.04), after accounting for stroke risk, presence of contraindications (OR = 0.18; 0.13 0.27), older age (OR = 0.30; 0.21 0.45), prophylaxis at admission (OR = 3.03; 2.08 4.43). OAT was positively associated with the stroke risk in the 2004 sample only. CONCLUSION: The guideline implementation has substantially improved the appropriateness of OAT at discharge, through a better evaluation at patient's individual level of the benefit-to-risk ratio.
Bo et al. (Fri,) conducted a observational in Non-valvular atrial fibrillation (n=701). Hospital guideline implementation for antithrombotic therapy vs. Pre-implementation (standard care) was evaluated on Appropriate oral anticoagulant therapy (OAT) prescription at discharge when strongly recommended (Absolute difference 25.3%, 95% CI 14.9-34.9). Implementing hospital guidelines for antithrombotic therapy increased appropriate oral anticoagulant prescription at discharge by an absolute 25.3% in patients with non-valvular atrial fibrillation.