Burden of Atrial Fibrillation: A Retrospective Review of Patients Presenting to Acute Medical Services.
Intern Med J. 2016 Aug 9;
Authors: Jolliffe E, Fu V, Lanford J, Weatherall M, Rosemergy I
BACKGROUND: Atrial fibrillation (AF) is a major risk factor for stroke and is associated with increased stroke severity and greater morbidity and mortality. Anti-coagulation is highly effective for preventing episodes of thromboembolism but remains under-utilised.
AIMS: To estimate the short-term risk of thromboembolic events in patients presenting with an acute medical illness; to assess rates of anti-coagulation in eligible patients with AF; and to describe physician decisions when prescribing anti-coagulation in a hospital setting.
METHODS: A retrospective cohort analysis of patients with AF presenting to acute medical services at Wellington Regional Hospital between 1(st) January 2012 and 31(st) December 2012 was performed.
RESULTS: 751 patient presentations with AF were identified. 613 unique patient encounters were eligible for analysis. 38.8% of patients with a CHA2 DS2 -VASc score ≥2 were discharged on anti-coagulation. The mean CHA2 DS2 -VASc score was 4.03 (SD 1.94). CHA2 DS2 -VASc score was not associated with being started on anti-coagulation OR 1.16 (95% CI 0.83 to 1.61), P = 0.38, but age by decade older was associated with a reduced likelihood of being started on anti-coagulation, OR 0.61 (95% CI 0.41 to 0.89), P = 0.01. In untreated patients with CHA2 DS2 -VASc score ≥2, the most frequently documented reasons not to initiate anti-coagulation were: decision deferred to the primary care physician 15.6%; falls risk or frailty 7.2%; and high bleeding risk 6.6%. However, no reason was documented in 56.9%. The thromboembolic rate in patients discharged without anti-coagulation within three months of presentation to acute medical services was 7/330 (2.1%).
CONCLUSION: Anti-coagulation for stroke prevention in AF remains under-utilised in eligible patients presenting to acute medical services at a tertiary level hospital.
PMID: 27501863 [PubMed - as supplied by publisher]