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Published on: February 28, 2012
Simple Criteria, Yet the Dearth Utilization-Antithrombotic Management Practice among Atrial Fibrillation Patients at
Mubarak Hussen1,2, Kindie Woubshet1,3, Seifu Bacha4
1Department of Internal Medicine, College of Medicine and Health Sciences, School of Medicine, P.O. Box 1560, Hawassa, Ethiopia.
Insights
Atrial fibrillation patients often receive suboptimal antithrombotic treatment, increasing stroke risk. Proper use of anticoagulation and CHA2DS2-VASc scores is crucial for effective stroke prevention in AF.
Area of Science:
- Cardiology
- Internal Medicine
- Pharmacology
Background:
- Atrial fibrillation (AF) significantly increases stroke and thromboembolism risk.
- Effective oral anticoagulation is available, yet many AF patients remain at high risk due to improper treatment.
- This study assesses antithrombotic therapy practices in AF patients at Hawassa University Comprehensive Specialized Hospital.
Purpose of the Study:
- To evaluate the current practices of antithrombotic therapy in adult cardiac clinic patients with atrial fibrillation.
- To identify gaps between recommended guidelines and actual treatment in AF patients.
- To assess the adequacy of anticoagulation in patients treated with warfarin.
Main Methods:
- Retrospective review of 119 patient charts with documented AF from January to December 2018.
- Recording of antithrombotic therapy indicators based on the CHA2DS2-VASc score.
- Statistical analysis using SPSS 23, with a p-value of 0.05 considered significant.
Main Results:
- Only 55% of AF patients received appropriate antithrombotic treatment.
- The majority of patients were female (70%) with a mean age of 48 years.
- Valvular AF required more appropriate antithrombotic therapy than nonvalvular AF (p<0.0001).
- Adequate anticoagulation was achieved in only 13.6% of warfarin users.
Conclusions:
- A significant discrepancy exists between recommended and practiced antithrombotic therapy for stroke prevention in AF patients.
- There is a need for improved patient adherence to proper antithrombotic utilization.
- Suboptimal anticoagulation in warfarin users and inadequate CHA2DS2-VASc score application require urgent attention.
Background:
Atrial fibrillation (AF) is associated with significant mortality and morbidity from stroke and thromboembolism. Despite the availability of effective oral anticoagulation medication, AF patients remain at a high risk of stroke if not treated properly. The purpose of this study was to evaluate antithrombotic therapy practices in patients with AF in the adult cardiac clinic at Hawassa University Comprehensive Specialized Hospital (HUCSH).
Methods:
It was a retrospective document review study. Total charts of 119 patients who had follow-up at the adult cardiac clinic with a history of documented AF from January 1 to December 30, 2018, were included. Indicators for antithrombotic therapy based on the congestive heart failure, hypertension, age ≥75 (doubled), diabetes, stroke (doubled), vascular disease, age 65 to 74, and sex category (female) (CHA2DS2-VASc) score were recorded. A p value of 0.05 was considered statistically significant. Data analysis was done using SPSS 23 software.
Results:
In this study, about 55% of patients with AF were receiving the appropriate antithrombotic treatment. The patients were 48 ± 18.2 years old. Of these, 70% were women. The most frequent underlying cardiac etiology was chronic rheumatic valvular heart disease (50%), followed by cardiomyopathy (14%). In nonvalvular AF, the mean CHA2DS2VASc score was 4.0 ± 1.07. In valvular AF compared to nonvalvular AF, the need for appropriate antithrombotic therapy was substantially greater (p 0.0001). Only 8 (13.6%) of the warfarin-using patients had adequate anticoagulation.
Conclusion:
The study's findings in regard to antithrombotic usage and maintenance of appropriate antithrombotics for stroke prevention in our patients revealed a discrepancy between recommendations and practice. Therefore, we demand that patients with AF who meet the criteria utilize antithrombotics properly to prevent stroke. Warfarin-taking patients' subpar optimum anticoagulation has to be addressed. Lastly, we advocate proper CHA2DS2-VASc score utilization for nonvalvular heart disease. A regular INR follow-up is also advised for patients who have started taking warfarin.
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