Key result
Real-world AF care in elderly Chinese patients reveals major gaps, leaving ~55% without oral anticoagulants.
Why the study?
Quality indicators have been proposed to assess care quality in real-world clinical practice, motivating an evaluation of quality measures and clinical performance indicators among elderly Chinese patients with AF.
Observational (n=6,420)
Yes
This large-scale registry highlights significant gaps in guideline-directed care for elderly Chinese patients with atrial fibrillation, particularly the severe underuse of oral anticoagulation in high-risk patients.
Answers are grounded in this paper and cite their sources.
Care gaps in anticoagulation persist in elderly Chinese AF; leaves open whether holistic quality programs improve outcomes in similar cohorts.
Aims To evaluate the quality measures and clinical performance indicators among elderly Chinese patients with atrial fibrillation (AF). The management of patients with AF requires a holistic, multidisciplinary approach. Quality indicators have been proposed to assess the quality of care in ‘real-world’ clinical practice when managing patients with AF. Methods and results The Optimal Thromboprophylaxis in Elderly Chinese Patients with Atrial Fibrillation (ChiOTEAF) registry is a prospective, observational, large-scale multicentre registry conducted between October 2014 and December 2018 in China. Data were collected at the enrolment and during the follow-up visits by the local investigators. In the ChiOTEAF registry, 14 primary and 8 secondary indicators from six domains of care were assessed. Six thousand four hundred twenty patients who completed the 1-year follow-up were included in the analysis. Median age was 76 years, and the majority of patients was male (60.8%). Overall, 3246 patients (54.8%) were not treated with oral anticoagulants (OACs) appropriate to their risk of stroke; specifically, among those at highest risk of stroke, OACs were prescribed in only 43.3% patients (1258/2905). Among patients with permanent AF, 32 (3.6%) were prescribed antiarrhythmic drugs, and among those with paroxysmal AF, catheter ablation was performed in 20.7%. Patients were overburdened with multi-morbidities, including hypertension, diabetes mellitus, obesity, and sleep apnoea. During 1-year follow-up, 435 deaths (6.8%) and 89 thromboembolic events (1.4%) occurred. Patient-reported outcomes showed that 55% of patients had indicators of reduced quality of life. Conclusion Assessment of quality indicators revealed the gaps in AF care among Chinese patients, highlighting the need for a more integrated or holistic approach to AF management.
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Guo et al. (2021) conducted an observational in Atrial fibrillation (n=6,420). Real-world management of atrial fibrillation was evaluated on Quality measures and clinical performance indicators. Real-world management of elderly Chinese patients with atrial fibrillation revealed significant care gaps, with 54.8% not receiving appropriate oral anticoagulants and a 6.8% 1-year mortality rate.
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