<--GAT-->
Clinical Topics

Improving OAC Adherence in Atrial Fibrillation Patients

by U.S. Medicine

April 16, 2019

DURHAM, NC—Treatment of atrial fibrillation patients isn’t always in line with clinical guidelines, but improving adherence to oral anticoagulation has proven to be challenging, according to a new study.

The article in Circulation reported on adherence to the American College of Cardiology/American Heart Association performance measures for OAC in eligible patients with a CHA2DS2-VASc≥2 and trends in prescription over time. Data from the American Heart Association’s Get With the Guidelines AFIB registry was used in the review, and adjusted associations with in-hospital outcomes also were determined.1

The Duke University-led study also involved VA researchers in Albany, NY, and Palo Alto, CA.

Overall, the cohort included 33,235 AF admissions with a CHA2DS2-VASc≥2 enrolled at 115 sites between Jan. 1, 2013, and Sept. 31, 2017. Participants’ median age was 73, 52% were female, and the median CHA2DS2-VASc score was 4.

At admission, 59.5% of participants with a prior diagnosis of AF were on OAC, which was associated with a lower adjusted odds of in-hospital ischemic stroke (OR 0.38, 95% CI 0.24-0.59, p<0.0001).

At discharge, prescription of OAC in eligible patients—i.e., no contraindications—was 93.5%. With analysis excluding only strict contraindications, that percentage dropped to 80.3%.

Researchers documented that frequency of OAC was higher in those age 75 and older, men, those with heart failure, patients with prior AF ablation and those with rhythm control. On the other hand, OAC use was found to be lowest in Hispanic patients.

The good news, according to the authors is that prescription of OAC at discharge in eligible patients improved over time from 79.9% to 96.6% .

“Among hospitals participating in the GWTG-AFIB quality improvement program, OAC prescription at discharge in eligible guideline-indicated patients increased significantly and improved consistently over time,” the researchers wrote. “These data confirm that high-level adherence to guideline recommended stroke prevention is achievable.”

Piccini JP, Xu H, Cox M, Matsouaka RA, et. Al. Get With The Guidelines-AFIB Clinical Working Group and Hospitals. Adherence to Guideline-Directed Stroke Prevention Therapy for Atrial Fibrillation is Achievable: First Results from Get With The Guidelines-Atrial Fibrillation (GWTG-AFIB). Circulation. 2019 Jan 31. doi: 10.1161/CIRCULATIONAHA.118.035909. [Epub ahead of print] PubMed PMID: 30700141.



Related Articles

HIV Patients Had Lower PC Incidence in VA Study

NEW YORK—Non-AIDS defining cancers are increasingly important contributors to health outcomes for aging persons with HIV (PWH), according to a recent conference presentation which also pointed out that, although prostate cancer is prevalent in aging... View Article

VA Study Finds No Link Between ADT, Dementia

LA JOLLA, CA—Research has been conflicting on whether androgen deprivation therapy is related to dementia. A research letter in JAMA Oncology pointed out that two studies reported a strong statistically significant association between ADT and... View Article


U.S. Medicine Recommends


More From cardiology

Cardiology

No Link Between Anthrax Vaccine, ‘Lone AFib’

ATLANTA—Concerns have been raised about a possible link between receipt of anthrax vaccine adsorbed and atrial fibrillation in military personnel without identifiable underlying risk factors or structural heart disease. A study in Human Vaccines &... View Article

Cardiology

NASA Partners with Academia for CVD Prediction Tool in Younger Adults

Federal medicine played a crucial role in the development of a new online tool to better predict which middle-aged adults are at the greatest risk of having acute myocardial infarction or stroke over the next decade.

Cardiology

VA Research Determines Which Beta Blocker Is Better in Heart Failure

ST. LOUIS—Current clinical guidelines recommend the use of beta blockers in all heart failure patients with with reduced ejection fraction (HFrEF). Which beta blocker to use—carvedilol or metoprolol succinate—remained unclear, however, according to a recent... View Article

Cardiology

New VA Analysis Refutes Link Between Heart Failure, Incident Cancer

With about 350,000 patients with heart failure diagnoses being treated in the VHA, recent studies suggesting that the cardiovascular condition increases risk of cancer have been worrisome.

Cardiology

Medications, interventions underused in veterans with peripheral artery disease

Nearly 30% of veterans with peripheral artery disease (PAD) die within four years of diagnosis, while others experience limb amputation or critical limb ischemia.

Subscribe to U.S. Medicine Print Magazine

U.S. Medicine is mailed free each month to physicians, pharmacists, nurse practitioners, physician assistants and administrators working for Veterans Affairs, Department of Defense and U.S. Public Health Service.

Subscribe Now

Receive Our Email Newsletter

Stay informed about federal medical news, clinical updates and reports on government topics for the federal healthcare professional.

Sign Up