Missed Opportunities to Initiate Oral Anticoagulant in Atrial Fibrillation: Insights from Australian Acute Coronary Syndrome Registries

Ma, Miles; Hyun, Karice; D’Souza, Mario; Chew, Derek P.; Brieger, David

doi:10.1016/j.hlc.2021.01.005

Cited by 2 publications

(1 citation statement)

References 37 publications

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“…An Australian study from the Cooperative National Registry of Acute Coronary Care, Guideline Adherence and Events (CONCORDANCE) and Global Registry of Acute Coronary Events (GRACE) registries found that 532 patients with a history of atrial fibrillation had oral anticoagulant (36%), 580 patients had antiplatelet (39%) and 367 patients had no antithrombotic therapy (39%) [22]. During the 18 years of the study, the use of oral anticoagulants increased from 27 to 56%.…”

Section: Other Missed Opportunities In Secondary Preventionmentioning

confidence: 99%

Missed opportunities in coronary artery disease: reflection on practice to improve patient outcomes

Kwok

Satchithananda

Mallen

2021

Coronary Artery Disease

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Missed opportunities refer to incidents where different actions by those involved could result in more desirable outcomes. While missed opportunities are not an established concept in coronary artery disease (CAD), they are important because CAD is common and potentially life-threatening. Treatment of CAD has the potential to prevent poor patient outcomes which can have a downstream consequence on resource utilization and costs for healthcare providers. The missed opportunities in CAD could be divided into those related to prevention, early detection, diagnosis and treatment. The primary prevention opportunities include the management of patients with risk factors and comorbidities. In terms of diagnosis, a proportion of patients who have underlying CAD are admitted beforehand with symptoms which may be attributed to CAD. However, some may have been misdiagnosed with other conditions and are subsequently readmitted with a delayed diagnosis of acute coronary syndrome. In acute coronary syndrome, there is a need for acute treatment and missed opportunities may arise from delay in diagnosis and missed reperfusion therapy. Finally, after coronary revascularization or medication management, there may be missed opportunities for patients related to secondary prevention such as smoking cessation, exercise, weight loss, attendance at cardiac rehabilitation and receipt evidenced-based therapies including antihypertensives, antiplatelet and statin therapy. Our review finds that missed opportunities can become apparent if looked for in the care of patients with CAD. While the term is nonspecific, it should be contextualized and described as those which are related to prevention, diagnosis and treatment. Only through reflection on clinical activities in relation to patient outcomes and the use of healthcare services can missed opportunities be identified so that better care can be delivered.

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Section: Other Missed Opportunities In Secondary Preventionmentioning

confidence: 99%