Programme no. 166-P
Prophylactic treatment with oral anticoagulants in atrial fibrillation
- are recommendations considered?
A survey in primary care in west-Sweden
Johanna Nilsson*1, Kristina Bengtsson Boström2, Paolina Weidinger3
1Närhälsan Hentorp Health centre, Skövde, Sweden,Skövde,Sweden, 2R&D Center Skaraborg,Närhälsan R&D Primary Care,Skövde,Sweden, 3R&D Center Skaraborg,Närhälsan R&D Primary Care,Skövde,Sweden;Department of Molecular and Clinical Medicine,The Sahlgrenska Academy, University of Gothenburg,Gothenburg,Sweden
* = Presenting author
Objectives: To study the treatment with anticoagulants among patients with atrial fibrillation at a primary health care center in west-Sweden.
Background: Atrial fibrillation is the most common cardiac arrhythmia among adults (2.9% in Sweden). For patients with this condition, the risk of having thromboembolic stroke is increased. Prophylactic treatment with anticoagulants, warfarin or new oral anticoagulants (NOAC) is recommended. This significantly reduces the risk. Former treatment with acetylsalicylic acid is no longer recommended. The adoption of the new recommendations in primary care is of interest.
Results: The prevalence of atrial fibrillation was 1.6% (n = 152). Among 144 patients, clinically predicted as high risk-patients by CHA2DS2-VASc, 72 % (n = 103) were treated according to recommendations with warfarin (68%; n = 98) or NOAC (3%; n = 5). For 41 patients (28%) acetylsalicylic acid was prescribed as mono-therapy or treatment were lacking completely. Among 63% of these patients, a reason for not treating according to recommendations could be found, most commonly former bleeding or that the patient denied treatment.
Material/Methods: In a retrospective observational study, all patients diagnosed with atrial fibrillation during 2011-2013 were identified (n = 235). Patients who switched health care center or deceased during the study period were excluded (n = 83). For 152 patients, information on prescribed anticoagulants, existing comorbid conditions and parameters for risk assessment according to CHA2DS2-VASc (score for atrial fibrillation stroke risk), were extracted from the medical records, as also reasons for not treating according to recommendations.
Conclusion: This study indicates underdiagnosis, since the prevalence of atrial fibrillation was lower than expected. Seventytwo percent of patients with atrial fibrillation in need of anticoagulants were treated according to recommendations which are higher than the 45% reported from the region in 2009. Still undertreatment exists. Improvement could be achieved among the patients lacking medication or prescribed acetylsalicylic acid, especially since new treatment options now are available.
Points for discussion: How to increase the detection and prophylactic treatment in atrial fibrillation.