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Published on: February 26, 2013
Improved Anticoagulation Guideline Adherence and Clinical Outcome Through Hospital-Wide Atrial Fibrillation Alarming
Tzu-Wei Liao1, Wei-Ta Chen2,3
1Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University.
Insights
A hospital-wide atrial fibrillation (AF) screening system significantly improved direct oral anticoagulant (DOAC) adherence in AF patients. This intervention reduced stroke rates while increasing minor bleeding events.
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.
Background:
Direct oral anticoagulation (DOAC) therapy has been approved for stroke prevention in atrial fibrillation (AF) patients. However, about 30% of patients with AF are not on oral anticoagulants (OACs). About 30% of patients on OACs are on off-label dosages.
Objective:
We used a hospital-wide AF screening system to improve the OAC guideline adherence rate. We also assessed the impact on clinical outcomes.
Methods:
All electrocardiograms (ECGs) of each hospitalized patient were screened using an AF screening system, regardless of whether the ECGs were obtained during or before hospitalization. Patients with AF were enrolled. The CHA2DS2-VAS score was calculated and appropriate DOACs were suggested to the primary care team. The DOAC guideline adherence rate was calculated. The annual stroke and bleeding rates were also calculated.
Results:
At baseline, the DOAC guideline adherence rate was only 40.6%. After the intervention, the guideline adherence rate increased to 82.5%. After discharge, the adherence rate did not decrease. The annual stroke rates for patients on guideline-recommended DOACs with and without our intervention were 2.79% and 3.12%, respectively. The annual stroke rate for patients on DOACs not adhering to the guidelines was 9.91%. The minor bleeding rate was significantly higher in the groups that adhered to the guidelines, but the major bleeding rate was not significantly different.
Conclusions:
Implementation of a hospital-wide AF screening system improved the DOAC guideline adherence rate and reduced the annual stroke rate for patients with AF. The minor bleeding rate was increased.
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