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.

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