What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Atrial fibrillation (n=432). Intervention: Anticoagulant therapy (Warfarin) vs. No anticoagulant therapy. Primary outcome: Proportion of patients with an absolute indication for anticoagulation (CHA2DS2-VASc score ≥2) receiving warfarin.

What question did this study set out to answer?

To assess the prevalence of atrial fibrillation, the distribution of thromboembolic risk factors, and adherence to guideline-recommended anticoagulant therapy in a cardiology outpatient setting.

May 1, 2012The Anatolian Journal of Cardiology

The frequency of embolic risk factors and adequacy of anti-embolic treatment in patients with atrial fibrillation: a single tertiary center experience

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Key result

Among atrial fibrillation patients with an absolute indication for anticoagulation, 67.3% were receiving warfarin, and 83.5% of those with available data achieved therapeutic INR levels.

Population

432 patients with a history of atrial fibrillation admitted to a tertiary cardiology outpatient clinic, mean…

Design

Cohort

Authors

EKEmir KaraçağlarUniversity of Leeds İAİlyas AtarTel Aviv University BYBegüm YetişMemorial Ankara Hospital

Discussion

Member takes

Implication

Undertreatment of indicated AF patients persists in tertiary care; leaves open current adherence rates and barriers in the NOAC era.

Key Points

To assess the prevalence of atrial fibrillation, the distribution of thromboembolic risk factors, and adherence to guideline-recommended anticoagulant therapy in a cardiology outpatient setting.
Conducted a retrospective review of 4,721 patients presenting to a tertiary cardiology outpatient clinic between January and June 2010.
Assessed demographic characteristics, AF classification, CHA2DS2-VASc scores, 12-month INR therapeutic control, and reasons for anticoagulant non-use.
Atrial fibrillation was present in 9.1% (n=432/4,721) of patients (mean age 70.4 years; 58.5% female), with hypertension as the predominant risk factor (71.9%).
Among 377 patients (87.2%) with a CHA2DS2-VASc score ≥ 2, 67.3% (n=254) were prescribed warfarin, while 15.9% remained untreated despite having a clear indication and no contraindications.
Therapeutic international normalized ratio (INR) levels were successfully maintained in 83.5% of patients actively receiving warfarin.

Study Design

Type

Cross-Sectional (n=432)

Multicenter

Structured PICO

Population

432 patients with atrial fibrillation evaluated retrospectively at a single tertiary cardiology clinic in Turkey to assess embolic risk factors and adequacy of anticoagulant therapy.

Exposure

Anticoagulant therapy (warfarin)

Outcome

Prevalence of AF, frequency of risk factors, and adequacy of anticoagulant therapy according to current guidelines

A substantial proportion of patients with atrial fibrillation and an indication for anticoagulation are not receiving guideline-directed therapy in a tertiary care setting.

Limitations

Small sample size and single-center design limit generalizability.
Retrospective evaluation may have led to underestimation of CHA2DS2-VASc scores due to lack of new screening for vascular diseases.
Potential selection bias as patients on antithrombotic therapy alone might have been missed if they did not visit during the 6-month window.
Lack of follow-up for bleeding complications.
INR control status may not reflect the true picture for patients not in regular follow-up.

Cite This Study

Karaçağlar et al. (2012) conducted a cross-sectional in Atrial fibrillation (n=432). Anticoagulant therapy (Warfarin) vs. No anticoagulant therapy was evaluated on Proportion of patients with an absolute indication for anticoagulation (CHA2DS2-VASc score ≥2) receiving warfarin. Among atrial fibrillation patients with an absolute indication for anticoagulation, 67.3% were receiving warfarin, and 83.5% of those with available data achieved therapeutic INR levels.

synapsesocial.com/papers/6a7c7c2364d932015f8f1336 https://doi.org/10.5152/akd.2012.123

Topics

Atrial fibrillation Anticoagulation in AF Persistent AF management AF ablation outcomes

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