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Evaluating Physician Adherence to Antithrombotic Recommendations in Patients with Atrial Fibrillation: A Pathway to
Ştefan Cristian Vesa1, Sonia Irina Vlaicu2, Octavia Sabin1
1Department of Pharmacology, Toxicology and Clinical Pharmacology, "Iuliu Haţieganu" University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania.
Insights
Physicians often undertreat atrial fibrillation patients with oral anticoagulants (OAC), failing to adhere to stroke risk guidelines. Treatment decisions were based on AF type, not the CHA2DS2-VASc score.
Area of Science:
- Cardiology
- Clinical Medicine
- Public Health
Background:
- Atrial fibrillation (AF) significantly increases stroke risk.
- Oral anticoagulants (OAC) are crucial for stroke prevention in AF patients.
- The CHA2DS2-VASc score stratifies stroke risk in AF, guiding OAC prescription.
Purpose of the Study:
- To evaluate physician adherence to OAC guidelines in non-valvular AF.
- To identify factors influencing OAC prescription decisions.
- To assess undertreatment and overtreatment rates based on risk scores.
Main Methods:
- Retrospective cross-sectional study of 784 non-valvular AF patients.
- Analysis of demographic data, AF subtype, comorbidities, and antithrombotic treatment.
- Comparison of OAC use against CHA2DS2-VASc risk stratification.
Main Results:
- 617 (78.7%) patients received OAC.
- 161 (96.4%) of 167 non-OAC patients were undertreated per CHA2DS2-VASc score.
- Paroxysmal AF subtype was most common among undertreated patients (60.5%).
Conclusions:
- Physician OAC prescribing decisions were primarily based on AF type, not stroke risk scores.
- Significant undertreatment of AF patients at high stroke risk was observed.
- Current practices deviate from established guidelines for stroke prevention in AF.
Background:
Atrial fibrillation is a major health problem due to the stroke risk associated with it. To reduce stroke risk, oral anticoagulants (OAC) are prescribed using the CHA2DS2-VASc (Congestive heart failure; Hypertension; Age ≥75 years; Diabetes Mellitus; Stroke; Vascular disease; Age 65-74 years; Sex category) risk score, a clinical probability assessment that includes a combination of risk factors predicting the probability of a stroke. Not all patients with high risk are receiving this treatment. The aim of this study was to assess physician adherence to clinical guidelines concerning the OAC treatment and to identify the factors that were associated with the decision to prescribe it.
Methods:
Registry data from 784 patients with non-valvular atrial fibrillation were evaluated in this retrospective cross-sectional study. Demographic data, subtype of AF, comorbidities associated with higher stroke and bleeding risk, and antithrombotic treatment received were recorded. We compared stroke and bleeding risk in patients with and without OAC treatment to determine if the clinicians followed guidelines: prescribed when necessary and abstained when not needed.
Results:
OAC treatment was administered in 617 (78.7%) patients. Of the 167 patients who did not receive OAC, 161 (96.4%) were undertreated according to their risk score, as opposed to those who received OAC in which the percentage of overtreated was 3.2%. Most undertreated patients (60.5%, p < 0.001) were with paroxysmal atrial fibrillation subtype.
Conclusions:
The decision to use anticoagulants for stroke prevention was based on the type of atrial fibrillation, rather than on the risk of stroke as quantified by CHA2DS2-VASc as per the recommended guidelines.