The Risk Stratification and Stroke Prevention Therapy Care Gap in Canadian Atrial Fibrillation Patients

Area of Science:

• Cardiology
• Primary Care Medicine
• Health Services Research

Background:

• Canadian guidelines mandate stroke and bleeding risk stratification for all atrial fibrillation (AF) patients.
• Most AF patients require antithrombotic therapy based on risk assessment.

Purpose of the Study:

• To evaluate the adherence of primary care physicians to AF guideline recommendations regarding risk stratification and antithrombotic therapy.
• To identify gaps in risk assessment and management of AF patients in Canadian primary care settings.

Main Methods:

• A chart audit of 4670 AF patients aged 18+ was conducted across 474 Canadian primary care practices.
• Data were collected between February and September 2011, excluding patients with significant valvular heart disease.

Main Results:

• Risk assessment for stroke and bleeding was omitted in 15% and 25% of patients, respectively.
• Predictive risk indices were used in only 50% (stroke) and 26% (bleeding) of cases where risk was assessed, with frequent over/underestimation.
• Warfarin was used in 90% of patients, but 24% had a Time in Therapeutic Range (TTR) below 50%, and 33% had TTR below 60%.

Conclusions:

• Significant gaps exist in primary care physicians' risk stratification and management of AF patients according to Canadian guidelines.
• Inconsistent use of validated risk indices and suboptimal Time in Therapeutic Range (TTR) for warfarin indicate a need for improved knowledge translation.
• Interventions are needed to enhance primary care physician's application of evidence-based practices for stroke prevention in AF.