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[Antithrombotic therapy in atrial fibrillation and additional stroke/embolism risk factors. CORSurvey Study]
C Stöllberger1, J Finsterer, J Slany
1Neurologisches Krankenhaus Rosenhügel, Wien. claudia.stoellberger@pips.co.at
Insights
In patients with atrial fibrillation and heart failure, antithrombotic therapy recommendations are often overlooked, particularly when stroke risk factors are present. This study highlights suboptimal prescribing practices in Austrian hospitals.
Area of Science:
- Cardiology
- Pharmacology
- Public Health
Context:
- Atrial fibrillation (AF) and heart failure (HF) are common comorbidities.
- Antithrombotic therapy is crucial for preventing stroke and embolism in these patients.
- Current guidelines recommend specific antithrombotic strategies based on risk factors.
Purpose:
- To assess the utilization of antithrombotic therapy in Austrian patients with AF and HF at hospital discharge.
- To investigate the influence of stroke risk factors and contraindications for oral anticoagulation on therapy choice.
- To examine departmental variations in antithrombotic prescribing patterns.
Summary:
- A survey of 1566 patients with AF and HF revealed that only 26% received oral anticoagulants (OAC), 31% acetylsalicylic acid (ASA), 2% OAC plus ASA, and 41% no antithrombotic therapy.
- Presence of stroke risk factors (age > 65, hypertension, diabetes, prior stroke) did not significantly alter therapy choice.
- Dementia, but not alcohol abuse, was associated with avoidance of OAC. OAC use was higher in cardiology departments.
Impact:
- Findings suggest a significant gap between clinical guidelines and real-world practice in managing antithrombotic therapy for AF and HF patients.
- Suboptimal prescribing, especially in the presence of risk factors, may lead to increased risk of thromboembolic events.
- Highlights the need for improved adherence to evidence-based recommendations and targeted interventions to optimize stroke prevention in this vulnerable population.
Objectives:
To evaluate 1) how many patients with atrial fibrillation (AF) and heart failure were discharged from Austrian hospitals with antithrombotic therapy, 2) if the presence of risk factors for stroke/embolism (age > 65 years, arterial hypertension, diabetes, and previous stroke) influence the choice of antithrombotic therapy and if the presence of contraindications for oral anticoagulation (dementia, alcohol abuse) influence the choice of antithrombotic therapy, and 3) if there are differences among the types of departments in the use of antithrombotic therapy.
Patients:
Included were 1566 patients (841 female, 725 male, mean age 76 years) with AF and heart failure.
Methods:
At discharge, a questionnaire was completed including risk factors, contraindications for antithrombotic therapy, and antithrombotic medication.
Results:
Oral anticoagulants (OAC) had 26% of the cases, acetyl salicylic acid (ASA) 31%, a combination of OAC and ASA 2%, and no antithrombotic therapy 41%. The risk factors age > 65 years, arterial hypertension, diabetes, and previous stroke did not influence the choice of antithrombotic therapy. Dementia but not alcohol abuse influenced the choice against OAC. The rate of OAC was higher in cardiological or cardiovascular rehabilitation clinics than in other departments.
Conclusion:
The results of this survey show that in medical practice the recommendations regarding antithrombotic therapy in atrial fibrillation are rarely considered, especially when additional risk factors are present.