Adherence to Guideline-Directed Stroke Prevention Therapy for Atrial Fibrillation Is Achievable

Get With The Guidelines-AFIB Clinical Working Group and Hospitals

Research output: Contribution to journalArticle

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Abstract

BACKGROUND: Efforts to improve prescription of oral anticoagulation (OAC) drugs in patients with atrial fibrillation have had limited success in improving guideline adherence. METHODS: We evaluated adherence to the American College of Cardiology/American Heart Association performance measures for OAC in eligible patients with a CHA2DS2-VASc score ≥2 and trends in prescription over time in the American Heart Association's Get With The Guidelines-AFIB (atrial fibrillation) registry. Adjusted associations with in-hospital outcomes were also determined. The cohort included 33 235 patients with a CHA2DS2-VASc score ≥2 who were admitted for atrial fibrillation and were enrolled at 115 sites between January 1, 2013, and September 31, 2017. RESULTS: The median (25th, 75th percentile) age was 73 years (65, 81 years); 51% were female; and the median (25th, 75th percentile) CHA2DS2-VASc score was 4 (3, 5). At admission, 16 206 (59.5%) of 27 221 patients with a previous diagnosis of atrial fibrillation were taking OAC agents, and OAC drug use at admission was associated with a lower adjusted odds of in-hospital ischemic stroke (odds ratio, 0.38; 95% CI, 0.24-0.59; P<0.0001). At discharge, prescription of OAC in eligible patients (no contraindications) was 93.5% (n=25 499 of 27 270). In a sensitivity analysis, when excluding only strict contraindications (4.6%, n=1497 of 32 806), OAC prescription at discharge was 80.3%. OAC prescription at discharge was higher in those aged ≤75 years, men, those with heart failure, those with previous atrial fibrillation ablation, and those with rhythm control ( P<0.0001 for all). OAC use was lowest in Hispanic patients (90.2%, P<0.0001). Prescription of OAC at discharge in eligible patients improved over time from 79.9% to 96.6% ( P<0.0001). CONCLUSIONS: 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. These data confirm that high-level adherence to guideline-recommended stroke prevention is achievable.

Original languageEnglish (US)
Pages (from-to)1497-1506
Number of pages10
JournalCirculation
Volume139
Issue number12
DOIs
StatePublished - Mar 19 2019

Fingerprint

Guideline Adherence
Atrial Fibrillation
Prescriptions
Stroke
Therapeutics
Guidelines
American Heart Association
Quality Improvement
Hispanic Americans
Pharmaceutical Preparations
Anticoagulants
Registries
Heart Failure
Odds Ratio

Keywords

  • atrial fibrillation
  • guideline adherence
  • measures
  • outcomes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Get With The Guidelines-AFIB Clinical Working Group and Hospitals. / Adherence to Guideline-Directed Stroke Prevention Therapy for Atrial Fibrillation Is Achievable. In: Circulation. 2019 ; Vol. 139, No. 12. pp. 1497-1506.
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title = "Adherence to Guideline-Directed Stroke Prevention Therapy for Atrial Fibrillation Is Achievable",
abstract = "BACKGROUND: Efforts to improve prescription of oral anticoagulation (OAC) drugs in patients with atrial fibrillation have had limited success in improving guideline adherence. METHODS: We evaluated adherence to the American College of Cardiology/American Heart Association performance measures for OAC in eligible patients with a CHA2DS2-VASc score ≥2 and trends in prescription over time in the American Heart Association's Get With The Guidelines-AFIB (atrial fibrillation) registry. Adjusted associations with in-hospital outcomes were also determined. The cohort included 33 235 patients with a CHA2DS2-VASc score ≥2 who were admitted for atrial fibrillation and were enrolled at 115 sites between January 1, 2013, and September 31, 2017. RESULTS: The median (25th, 75th percentile) age was 73 years (65, 81 years); 51{\%} were female; and the median (25th, 75th percentile) CHA2DS2-VASc score was 4 (3, 5). At admission, 16 206 (59.5{\%}) of 27 221 patients with a previous diagnosis of atrial fibrillation were taking OAC agents, and OAC drug use at admission was associated with a lower adjusted odds of in-hospital ischemic stroke (odds ratio, 0.38; 95{\%} CI, 0.24-0.59; P<0.0001). At discharge, prescription of OAC in eligible patients (no contraindications) was 93.5{\%} (n=25 499 of 27 270). In a sensitivity analysis, when excluding only strict contraindications (4.6{\%}, n=1497 of 32 806), OAC prescription at discharge was 80.3{\%}. OAC prescription at discharge was higher in those aged ≤75 years, men, those with heart failure, those with previous atrial fibrillation ablation, and those with rhythm control ( P<0.0001 for all). OAC use was lowest in Hispanic patients (90.2{\%}, P<0.0001). Prescription of OAC at discharge in eligible patients improved over time from 79.9{\%} to 96.6{\%} ( P<0.0001). CONCLUSIONS: 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. These data confirm that high-level adherence to guideline-recommended stroke prevention is achievable.",
keywords = "atrial fibrillation, guideline adherence, measures, outcomes",
author = "{Get With The Guidelines-AFIB Clinical Working Group and Hospitals} and Piccini, {Jonathan P.} and Haolin Xu and Margueritte Cox and Matsouaka, {Roland A.} and Fonarow, {Gregg C.} and Javed Butler and Curtis, {Anne B.} and Nihar Desai and Margaret Fang and McCabe, {Pamela J.} and Page, {Robert L.} and Mintu Turakhia and Russo, {Andrea M.} and Knight, {Bradley Paul} and Mandeep Sidhu and Hurwitz, {Jodie L.} and Ellenbogen, {Kenneth A.} and Lewis, {William R.}",
year = "2019",
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doi = "10.1161/CIRCULATIONAHA.118.035909",
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Get With The Guidelines-AFIB Clinical Working Group and Hospitals 2019, 'Adherence to Guideline-Directed Stroke Prevention Therapy for Atrial Fibrillation Is Achievable', Circulation, vol. 139, no. 12, pp. 1497-1506. https://doi.org/10.1161/CIRCULATIONAHA.118.035909

Adherence to Guideline-Directed Stroke Prevention Therapy for Atrial Fibrillation Is Achievable. / Get With The Guidelines-AFIB Clinical Working Group and Hospitals.

In: Circulation, Vol. 139, No. 12, 19.03.2019, p. 1497-1506.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Adherence to Guideline-Directed Stroke Prevention Therapy for Atrial Fibrillation Is Achievable

AU - Get With The Guidelines-AFIB Clinical Working Group and Hospitals

AU - Piccini, Jonathan P.

AU - Xu, Haolin

AU - Cox, Margueritte

AU - Matsouaka, Roland A.

AU - Fonarow, Gregg C.

AU - Butler, Javed

AU - Curtis, Anne B.

AU - Desai, Nihar

AU - Fang, Margaret

AU - McCabe, Pamela J.

AU - Page, Robert L.

AU - Turakhia, Mintu

AU - Russo, Andrea M.

AU - Knight, Bradley Paul

AU - Sidhu, Mandeep

AU - Hurwitz, Jodie L.

AU - Ellenbogen, Kenneth A.

AU - Lewis, William R.

PY - 2019/3/19

Y1 - 2019/3/19

N2 - BACKGROUND: Efforts to improve prescription of oral anticoagulation (OAC) drugs in patients with atrial fibrillation have had limited success in improving guideline adherence. METHODS: We evaluated adherence to the American College of Cardiology/American Heart Association performance measures for OAC in eligible patients with a CHA2DS2-VASc score ≥2 and trends in prescription over time in the American Heart Association's Get With The Guidelines-AFIB (atrial fibrillation) registry. Adjusted associations with in-hospital outcomes were also determined. The cohort included 33 235 patients with a CHA2DS2-VASc score ≥2 who were admitted for atrial fibrillation and were enrolled at 115 sites between January 1, 2013, and September 31, 2017. RESULTS: The median (25th, 75th percentile) age was 73 years (65, 81 years); 51% were female; and the median (25th, 75th percentile) CHA2DS2-VASc score was 4 (3, 5). At admission, 16 206 (59.5%) of 27 221 patients with a previous diagnosis of atrial fibrillation were taking OAC agents, and OAC drug use at admission was associated with a lower adjusted odds of in-hospital ischemic stroke (odds ratio, 0.38; 95% CI, 0.24-0.59; P<0.0001). At discharge, prescription of OAC in eligible patients (no contraindications) was 93.5% (n=25 499 of 27 270). In a sensitivity analysis, when excluding only strict contraindications (4.6%, n=1497 of 32 806), OAC prescription at discharge was 80.3%. OAC prescription at discharge was higher in those aged ≤75 years, men, those with heart failure, those with previous atrial fibrillation ablation, and those with rhythm control ( P<0.0001 for all). OAC use was lowest in Hispanic patients (90.2%, P<0.0001). Prescription of OAC at discharge in eligible patients improved over time from 79.9% to 96.6% ( P<0.0001). CONCLUSIONS: 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. These data confirm that high-level adherence to guideline-recommended stroke prevention is achievable.

AB - BACKGROUND: Efforts to improve prescription of oral anticoagulation (OAC) drugs in patients with atrial fibrillation have had limited success in improving guideline adherence. METHODS: We evaluated adherence to the American College of Cardiology/American Heart Association performance measures for OAC in eligible patients with a CHA2DS2-VASc score ≥2 and trends in prescription over time in the American Heart Association's Get With The Guidelines-AFIB (atrial fibrillation) registry. Adjusted associations with in-hospital outcomes were also determined. The cohort included 33 235 patients with a CHA2DS2-VASc score ≥2 who were admitted for atrial fibrillation and were enrolled at 115 sites between January 1, 2013, and September 31, 2017. RESULTS: The median (25th, 75th percentile) age was 73 years (65, 81 years); 51% were female; and the median (25th, 75th percentile) CHA2DS2-VASc score was 4 (3, 5). At admission, 16 206 (59.5%) of 27 221 patients with a previous diagnosis of atrial fibrillation were taking OAC agents, and OAC drug use at admission was associated with a lower adjusted odds of in-hospital ischemic stroke (odds ratio, 0.38; 95% CI, 0.24-0.59; P<0.0001). At discharge, prescription of OAC in eligible patients (no contraindications) was 93.5% (n=25 499 of 27 270). In a sensitivity analysis, when excluding only strict contraindications (4.6%, n=1497 of 32 806), OAC prescription at discharge was 80.3%. OAC prescription at discharge was higher in those aged ≤75 years, men, those with heart failure, those with previous atrial fibrillation ablation, and those with rhythm control ( P<0.0001 for all). OAC use was lowest in Hispanic patients (90.2%, P<0.0001). Prescription of OAC at discharge in eligible patients improved over time from 79.9% to 96.6% ( P<0.0001). CONCLUSIONS: 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. These data confirm that high-level adherence to guideline-recommended stroke prevention is achievable.

KW - atrial fibrillation

KW - guideline adherence

KW - measures

KW - outcomes

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DO - 10.1161/CIRCULATIONAHA.118.035909

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JF - Circulation

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