Key result
When accounting for documented reasons to withhold anticoagulation, 81% of patients with atrial fibrillation were discharged on appropriate antithrombotic therapy (OR 1.57; 95% CI 1.26-1.96; P<0.0001).
Observational (n=293)
No
Odds Ratio: 1.57 (95% CI 1.26–1.96)
p-value: p=<.0001
The majority of patients with atrial fibrillation are discharged on appropriate antithrombotic therapy when accounting for documented reasons to withhold anticoagulation, though falls risk is frequently cited and should be reconsidered.
Suboptimal antithrombotic adherence at AF discharge (63%) signals implementation gaps; leaves open whether targeted interventions improve outcomes.
Background: Risk stratification for stroke in patients with atrial fibrillation is a vital step in identifying whether antithrombotic therapy is indicated for stroke prevention in this common arrhythmia. Purpose: The aim of this study was to determine adherence to guideline-directed antithrombotic therapy based on Congestive Heart Failure (1 point), Hypertension (1 point), Age (≥75 years old is 2 points and 65-74 is 1 point), Diabetes (1 point), prior Stroke (2 points), Vascular Disease (1 point), and Sex Category (1 point if female; CHA 2 DS 2 –VASc) score in patients with atrial fibrillation (AF) on hospital discharge. Methods: A total of 293 patients discharged from this academic medical center with a history of atrial fibrillation from June 2014 to June 2016 were enrolled. Demographic data and indicators for antithrombotic therapy based on the CHA 2 DS 2 –VASc score were recorded, and factors that affected adherence to guideline-directed therapy, such as bleeding risk, falls, and alcohol abuse, were collected and analyzed. Results: At hospital discharge, 63% of patients with AF were on appropriate antithrombotic therapy, 50% with a CHA 2 DS 2 –VASc score ≥2. The odds ratio of appropriate therapy in patients with a CHA 2 DS 2 –VASc score ≥2 was 1.17 (95% confidence interval [CI]: 0.95-1.30; P = .18). When chart documentation for reasons to withhold anticoagulation was considered as appropriate therapy, 81% of patients with AF were discharged on appropriate antithrombotic therapy with an odds ratio of 1.57 (95% CI: 1.26 -1.96, P < .0001), with bleeding and falls risk as the most common reasons to withhold anticoagulation. Conclusion: Based on risk stratification of stroke through the CHA 2 DS 2 –VASc score, the majority of patients with AF were discharged from the hospital on appropriate antithrombotic therapy. Withholding anticoagulation due to falls risk should be reconsidered as a result of the known benefits of stroke prevention in atrial fibrillation.
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Dupree et al. (2018) conducted an observational in Atrial fibrillation (n=293). CHA2DS2-VASc score ≥2 was evaluated on Appropriate antithrombotic therapy (including documented reasons to withhold) (OR 1.57, 95% CI 1.26-1.96, p=<.0001). When accounting for documented reasons to withhold anticoagulation, 81% of patients with atrial fibrillation were discharged on appropriate antithrombotic therapy (OR 1.57; 95% CI 1.26-1.96; P<0.0001).
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