2398 High adherence to anticoagulation guidelines for stoke patients with atrial fibrillation at a regional NSW hospital

Atrial fibrillation (AF), a cause of heart arrythmia, is a risk factor for stroke.^1–8 In 2018, the updated Australian Heart Foundation guidelines strongly recommended provision of anticoagulants to patients with AF to mitigate stroke risk.⁸

Methods/Objectives This study aimed to determine the proportion of patients with AF who are managed effectively for the mitigation of stroke according to these guidelines. This was achieved via a small-scale, observational retrospective cohort study/clinical audit at the Orange Health Service (OHS). This research analysed the proportion of patients admitted to OHS between 2018 and 2020 with acute stroke or transient ischaemic attack (TIA) along with a clinical history or discharge diagnosis of AF. Data was analysed in two steps; firstly, all patient admission files were screened for the presence of a history of or discharge diagnosis of AF. Secondly, patient files that met this screening criteria were reviewed to determine the appropriateness of their management according to the guidelines, while additionally identifying further risk factors.

Results As part of the study, a total of 191 individual stroke admissions were screened. Our results demonstrated an adherence to anticoagulation therapy guidelines in 16/19 (84%) patients prior to admission with a history of AF and an adherence of 21/24 patients (87.5%) following their stroke admission to the OHS with a discharge diagnosis of AF.

Conclusions Our small-scale study’s results suggested high rates of adherence to anticoagulation therapy guidelines at the OHS, consistent with contemporary literature in the rural and metropolitan clinical environment.^{5 9–13}

References

1. Manning W. Stroke in patients with atrial Fibrillation; UpToDate [Internet]. Waltham (MA): UpToDate Inc; 2019 [Updated 2021 May 25; Cited 2021 Oct 20]. Available from: https://www.uptodate.com/contents/stroke-in-patients-with-atrial-fibrillation.

2. Camm A, Lip G, De Caterina A, et al. Focussed update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC guidelines for the management of atrial fibrillation. European Heart Journal. 2012;33(21):2719–2747. doi: 10.1093/eurheartj/ehs253

3. Kamel H, Healey J. Cardioembolic Stroke, Circulation. 2017;120(3):514–526. doi: 10.1161/CIRCRESAHA.116.308407

4. Manning WJ, Singer DE, Gregory YH. Atrial fibrillation: anticoagulant therapy to prevent thromboembolism. UpToDate [Internet]. Waltham (MA): UpToDate Inc; 2018 [Updated 2021 Aug 24; Cited 2021 Oct 20]. Available from: https://www.uptodate.com/contents/atrial-fibrillation-anticoagulant-therapy-to-prevent-thromboembolism#H31.

5. Miao B, Hernandez A, Roman Y, Alberts M, Coleman C, Baker W. Four-year incidence of major adverse cardiovascular events in patients with atherosclerosis and atrial fibrillation. Clinical Cardiology. 2020;43(5):524–531. doi: 10.1002/clc.23344.

6. Wolf P, Abbott R, Kannel W. Atrial Fibrillation as an independent risk factor for stroke: The Framingham Study. Stroke. 1991;22(8):983–988. doi: 10.1161/01.STR.22.8.983.

7. Yaghi S, Kamel H. Stratifying Stroke Risk in Atrial Fibrillation: Beyond Clinical Risk Scores. Stroke. 2017;48(10):2665–2670. doi: 10.1161/STROKEAHA.117.017084.

8. Brieger D, et al. National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Australian clinical guidelines for the diagnosis and management of atrial fibrillation. Medical Journal of Australia. 2018;209(8):356–362. doi: 10.5694/mja18.00646.

9. Schaffer A, et al. Evidence-Practice Gaps in Postdischarge Initiation with Oral anticoagulants in Patients with Atrial Fibrillation. Journal of the American Heart Association. 2019;8(24). doi: 10.1161/JAHA.119.014287.

10. Stefani M, Parkin R, Anne S, O’Neill S. An audit of atrial fibrillation management in a rural teaching hospital. Elsevier. 2017;26(2). doi: 10.1016/j.hlc.2017.06.564.

11. Sharobeam A, Jones B, Watters A, Das C, Lueck C. Anticoagulant prescribing in patients with ischaemic stroke: what has changed over a decade?. Internal Medicine Journal. 2020;50: 1274–1277. doi: 10.1111/imj.15022.

12. Olivia C, Hastie C, Farshid A. Adherence to guidelines regarding anticoagulation and risk factors for progression of atrial fibrillation in a nurse-led clinic. Internal Medicine Journal. 2021;51(7):1136–1142. doi: 10.1111/imj.14874.

13. Bellinge J, Paul J, Walsh L, Garge L, Watts G, Schultz C. The impact of non-vitamin K antagonist oral anticoagulants (NOACs) on anticoagulation therapy in rural Australia. Medical Journal of Australia. 2018;208(1):18–23. doi: 10.5694/mja17.00132.