Key result
EHR screening identifies ~10% oral anticoagulation underprescription in eligible primary care AF patients.
Why the study?
The study was conducted to investigate the underprescription of oral anticoagulation in individual atrial fibrillation patients in primary care.
Cross-Sectional (n=2,375)
Yes
Although OAC underprescription in Dutch primary care AF patients is relatively low (9.8%), three-quarters of untreated high-risk patients lack documented reasons for withholding therapy and on-demand screening rarely prompted treatment initiation (10%).
Answers are grounded in this paper and cite their sources.
Undocumented withholding predominates despite low underprescription; leaves open whether targeted documentation improves OAC uptake in primary care AF.
OBJECTIVES: To investigate the underprescription of oral anticoagulation (OAC) in individual atrial fibrillation (AF) patients in primary care. SETTING: Screening of patient records in 39 participating general practitioners (GPs) across the Netherlands. PARTICIPANTS: We screened 101 207 patient records identifying 2375 non-valvular AF patients. In case of a deviation from guidelines recommended OAC prescription, we checked the electronic patient file for any documented reason. Additionally, 6 weeks following the screening, we asked all GPs to provide information on any actions taken for the underprescribed patients. OAC prescription consisted of direct OAC in 1342/1984 (68%) and vitamin K-antagonists in the remainder of patients. OAC underprescription was present in 93/944 (9.9%) females and 101/1374 (9.7%) in males, respectively. In 111/146 (76.0%) of the underprescribed AF patients, no reason to withhold OAC was reported. Reported reasons to withhold OAC were patient refusal (n=10), cardiologist advice (n=7) and high risk of bleeding (n=7). Data regarding actions following the identification of OAC underprescription were available for 92/194 (47%) of the OAC underprescribed cases. After consultation OAC was initiated in 9/92 (10%) only. CONCLUSIONS: In this large Dutch study among GPs, we observed 9.8% underprescription of OAC in AF patients. In 76% of the AF patients lacking a prescription for OAC, no documentation for deviating from the guidelines was found. Only in a minority of cases detection of OAC underprescription lead to OAC initiation.
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Voorhout et al. (2023) conducted a cross-sectional in Non-valvular atrial fibrillation (n=2,375). On-demand electronic health record screening for oral anticoagulation underprescription was evaluated on Underprescription of oral anticoagulation in AF patients with a guideline indication (CHA2DS2-VASc score ≥2). Screening of 2,375 non-valvular AF patients in Dutch primary care revealed a 9.8% oral anticoagulation underprescription rate, with 76.0% lacking a documented reason and 10% initiating therapy.
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