Programme no. 563-P
Quality Improvement
Atrial fibrillation patients – a quality challenge
Emil Heinäaho*1, Klas Winell2
1Conmedic, Loviisa Health Center,Helsinki,Finland, 2Conmedic,Helsinki,Finland
* = Presenting author
Objectives: We aimed to study the actual quality of the treatment of CAF patients.

Background: There is very little systematic quality improvement done with chronic atrial fibrillation (CAF) patients. The Finnish Quality Network (FQN) decided to start systematic QI with this patient group.
Results: The sample size was 1156 CAF patients, females 48.8% and 28.9% were over 80 years of age. Only 36 patients (3.1%) had a differing (not 2 to 3) therapeutic goal of INR test. Warfarin was the antithrombotic therapy of 97.3% of CAF patients. 57.0% of warfarin patients were in good therapeutic balance (Time in Therapeutic Range, TTR >70%) and 22.0% in poor therapeutic balance (TTR <50%). CHA2DS2VASc (thrombosis risk) score was calculated and registered in the patient record of 13.3% and HAS-BLED (bleeding risk) score of 10.3% CAF patients. 5.0% of patients suffered of severe symptoms of CAF. The warfarin dose was determined by nurses in 82.0% of patients. Five patients (0.4%) decided themselves about the warfarin dose. The therapeutic balance did not differ if it was a GP, nurse or patient who decided about the warfarin dose. However, the balance was significantly better if the HC had named nurses or physicians responsible for warfarin dose decisions.

Material/Methods: Ten Finnish health centres (HC) participated in the quality measurement of CAF treatment. The data was collected during all consultations and telephone contacts of CAF patients during two weeks. The indicators were based on the Finnish Current Care Guidelines and international literature. The analyses were made by SPSS Statistics program 20.0. Different organizational factors’ influence was tested by multivariate regression analysis.

Conclusion: There is a need for improving antithrombotic treatment. The use of CHA2DS2VASc and HAS-BLED risk tests should be increased. It seems that the decisions of warfarin dosing should be concentrated to a few nurses and physicians. The quality measurement will be repeated yearly. The next measurement will be in February 2015. The results will be reported during the Nordic GP meeting.
Points for discussion: How do we make the best use of these results in our every day work life? What are the ways to make sure that risk test are used routinely?