What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Atrial fibrillation (n=484). Intervention: Oral anticoagulation vs. No oral anticoagulation. Primary outcome: Estimated rate of preventable strokes per year due to neglected anticoagulation.

December 2, 2006Open Access

Atrial fibrillation: estimated excess rate of stroke due to lacking adherence to guidelines

Key Result

Neglected oral anticoagulation in 31% of eligible patients with atrial fibrillation resulted in an estimated preventable stroke rate of 4.9% per year.

Study Design

Type

Cross-Sectional (n=484)

Multicenter

Structured PICO

Does adherence to guideline-directed oral anticoagulation prevent strokes in patients with atrial fibrillation?

Population

484 consecutive patients with paroxysmal or permanent atrial fibrillation admitted to the medical or surgical department of a single hospital, mean age 75, 45% female.

Intervention

Oral anticoagulation according to guidelines

Comparator

No oral anticoagulation at hospital discharge despite guideline recommendations and no contraindications

Outcome

Estimated increased rate of cerebrovascular events (strokes) due to neglected anticoagulationhard clinical

A significant proportion of atrial fibrillation patients lack guideline-directed oral anticoagulation without contraindications, leading to a substantial estimated rate of preventable strokes.

Limitations

Analysis is based on stroke rates of a meta-analysis of a population with a different amount of risk factors
Results primarily reflect the poor quality of adherence to guidelines in a single hospital
Potential contraindications were identified according to patient records and not by directly asking the treating physicians
Data were assessed retrospectively from the year 2000

Abstract

QUESTIONS UNDER STUDY: Many patients with atrial fibrillation (AF), risk factors for stroke and no obvious contraindications do not receive oral anticoagulation. Estimations of the increased rate of stroke due to neglected anticoagulation, particularly in an elderly, non-selected population, are unknown. METHODS: Consecutive patients with paroxysmal or permanent atrial fibrillation admitted to the medical or surgical department of our hospital for any reason were studied. Risk factors for stroke and contraindications for anticoagulation were recorded. Estimations of the increased rate of cerebrovascular events due to neglected anticoagulation were based on data of a large meta-analysis. Patients were further stratified into different age and risk groups. RESULTS: 484 patients with a mean age of 75 (12) years were studied, 45% were female. 237 patients had no oral anticoagulation at hospital discharge, despite guideline recommendations. Contraindications for anticoagulation were found in 85 (36%) of these patients, resulting in 152 patients with neglected anticoagulation (31% of all patients with AF). We estimated that, if all those patients would have been treated according to guidelines, 7.4 strokes per year could be prevented in the study population. The estimated rate of preventable events was 4.9%/year (7.4/152). CONCLUSIONS: With better adherence to guidelines for oral anticoagulation in patients with atrial fibrillation and risk factors for stroke, a significant number of strokes could be prevented.

Mark Helpful

Bookmark

Relay

View Full Paper