District versus academic hospitals: differences in the clinical characteristics of patients with atrial fibrillation without valvular heart disease treated with oral anticoagulants

Abstract

INTRODUCTION Atrial fibrillation (AF) is the most common cardiac arrhythmia with a significant risk of morbidity and mortality. Non-vitamin K antagonist oral anticoagulants are the first‑line drugs in stroke prevention in patients with AF. Oral anticoagulant (OAC) therapy may differ between medical centers. OBJECTIVES We compared the clinical characteristics of AF patients treated with OAC in a district and an academic hospital. PATIENTS AND METHODS We analyzed 3528 patients from the multicenter retrospective CRAFT study: 2666 patients from the academic hospital and 862 patients from the district hospital. Their baseline clinical characteristics were compared. RESULTS Patients treated in the district hospital were older (mean [SD] age, 73.9 [10.3] years vs 66.0 [13.4] years; P <0.001) and more likely female (49.1% vs 37.4%; P <0.001). Patients treated in the academic hospital more frequently had paroxysmal AF, while those in the district hospital, permanent AF. The latter group was also more likely to have comorbidities and a higher frequency of previous bleeding episodes or anemia. The groups did not differ regarding kidney function. In both groups, patients were significantly more likely to be on rivaroxaban than on dabigatran. The group treated in the district hospital were at higher risk of thromboembolic events than the other gruop (mean [SD] CHA2DS2VASc score, 4.6 [1.7] vs 3.05 [2.0]; P <0.001), as well as of hemorrhagic events (mean [SD] HASBLED score, 0.6 [0.7] vs 0.4 [0.6]; P <0.001). CONCLUSIONS Patients with AF treated with OACs in the district and academic hospitals have different clinical characteristics. Patients treated in the district hospital were older, had more comorbidities, more frequently had permanent AF, and were at higher risk of thromboembolic and bleeding events than patients treated in the academic hospital.

Bleeding Tolerance Among Patients With Atrial Fibrillation on Oral Anticoagulation

“…Heart failure was the key comorbidity that increases the stroke risk and significantly affects the patients attitude to the adverse events. A prevalence of heart failure among AF patients is estimated to be 30-35% [26,27], which is similar to the proportion reported by us. It is known that heart failure is often associated with numerous hospital stays and several chronic comorbidities requiring multiple medications [26,27], which might affect the Bleeding Ratio among patients with heart failure.…”

“…A prevalence of heart failure among AF patients is estimated to be 30-35% [26,27], which is similar to the proportion reported by us. It is known that heart failure is often associated with numerous hospital stays and several chronic comorbidities requiring multiple medications [26,27], which might affect the Bleeding Ratio among patients with heart failure. Subsequently the patients need more attention of the treating physician to ensure good adherence to OAC on a long-term basis [28].…”

Educational needs among physicians treating patients with atrial fibrillation: lessons for Poland from the European Society of Cardiology international educational needs assessment study

“…This would be especially interesting with regard to a significant disparity in the clinical profile and knowledge among patients with AF derived from university and nonuniversity hospitals in Poland. 17,18 However, a country -specific analysis could overcome those limitations to some degree. Clinical experience shows that a fraction of patients with AF is diagnosed and treated ad hoc at emergency departments without the direct involvement of any of the specialists included in the survey, which is not discussed in our study.…”

Evaluation of a pharmacist-led intervention to improve medication adherence in patients initiating dabigatran treatment: a comparison with standard pharmacy practice in Poland

“…For primary prevention of thromboembolic events in patients with non-valvular AF and secondary prevention in those with VTE, oral anticoagulant therapy is recommended. Until 2010, vitamin K antagonists, such as warfarin, were the only oral anticoagulants on the market in Poland [5]. Non-vitamin K antagonist oral anticoagulants (NOACs) such as dabigatran are now the preferred treatment for AF and are recommended by the European Society of Cardiology [6].…”