Underuse of Oral Anticoagulation Therapy in Older Adults With Atrial Fibrillation After Stroke

Background and Purpose: There was an identified underuse of oral anticoagulation (OAC) among individuals who are over the age of 65 with atrial fibrillation (AF). The purpose of this DNP project was to identify patients aged 65 or older with a diagnosis of AF and a cerebral vascular accident (CVA) or transient ischemic attack (TIA), not on current OAC to determine if a prescription was provided to them at time of discharge from the hospital or during a post-hospitalization follow up appointment with their primary care or cardiology provider. Method: A retrospective medical record review was used over a three-month period in 2016 to determine clinical practice of providers prescribing OAC to patient ages 65 and older with AF and known stroke or TIA diagnosis. An evidence-based clinical decision support algorithm for the treatment of those with AF who had a CVA or TIA was implemented over a 12-week period at a large, independent hospital using the ACE Star Model of Knowledge Transformation, a framework for putting evidence-based processes into operation. The risk for stroke and bleeding was calculated using the CHA2DS2-VASc score and HAS-BLED tools. Following the implementation period, the same three-month span was selected in 2017 for a retrospective record review to determine the effectiveness of the intervention. Results: A total of 27 patients were included in this project. The number of eligible patients who were offered prescriptions for OAC increased from 87% in 2016 to 100% in 2017. Conclusion: The intervention resulted in the desired change towards evidence-based practice among providers. Following implementation of the project discharging providers not only included neurology’s recommendations in their discharge notes, but also provided prescriptions to eligible patients rather than leaving it to the patient’s primary care provider to initiate.