Improved Anticoagulation Guideline Adherence and Clinical Outcome Through Hospital-Wide Atrial Fibrillation Alarming...

Area of Science:

• Cardiology
• Clinical Pharmacy
• Public Health

Background:

• Direct oral anticoagulants (DOACs) are indicated for stroke prevention in atrial fibrillation (AF).
• A significant proportion of AF patients remain untreated or undertreated with oral anticoagulants (OACs).
• Off-label DOAC dosing is common, impacting therapeutic efficacy and safety.

Purpose of the Study:

• To evaluate the impact of a hospital-wide AF screening system on OAC guideline adherence.
• To assess the effect of improved adherence on clinical outcomes, including stroke and bleeding rates.

Main Methods:

• Implementation of a systematic AF screening protocol utilizing electrocardiograms (ECGs) for all hospitalized patients.
• Calculation of CHA2DS2-VAS scores and recommendation of appropriate DOACs to primary care teams.
• Prospective monitoring of DOAC guideline adherence, annual stroke rates, and bleeding events.

Main Results:

• DOAC guideline adherence increased from 40.6% at baseline to 82.5% post-intervention, with sustained adherence after discharge.
• Annual stroke rates decreased for patients on guideline-recommended DOACs.
• Patients adhering to DOAC guidelines experienced a significantly higher rate of minor bleeding but no significant difference in major bleeding.

Conclusions:

• A hospital-wide AF screening system effectively enhances DOAC guideline adherence in AF patients.
• Improved adherence is associated with a reduction in annual stroke rates.
• Increased minor bleeding is a potential consequence of guideline-adherent DOAC therapy.