Prescribing of anticoagulation for atrial fibrillation in primary care

Martinez, Kathryn A.; Eckman, Mark H.; Pappas, Matthew A.; Rothberg, Michael B.

doi:10.1007/s11239-022-02655-z

Cited by 5 publications

(2 citation statements)

References 47 publications

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“…This low-cost, easily accessible, and effective E-mail intervention serves to improve preventative care among underserved populations, who have limited access to subspecialty care and, like our study patient population, rely on primary care for preventative cardiovascular care. 15 A study assessing prescription of anticoagulation for AF by primary care physicians reported a rate of 47%, 16 indicating a critical area of improvement for a vulnerable patient population. Empowering primary care providers with educational interventions can improve guideline-based care, leading to more equitable health care delivery, reduction in health care disparities, and improved preventative care in the underserved.…”

Section: Discussionmentioning

confidence: 99%

A targeted educational intervention increases oral anticoagulation rates in high-risk atrial fibrillation patients

Dutta,

Ryan,

Hurley

et al. 2024

Heart Rhythm O2

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Section: Discussionmentioning

confidence: 99%

A targeted educational intervention increases oral anticoagulation rates in high-risk atrial fibrillation patients

Dutta,

Ryan,

Hurley

et al. 2024

Heart Rhythm O2

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“…However, concerns have been raised regarding the limitations of the CHA 2 DS 2 -VASc score, including inadequate specificity in predicting AF-related versus non-AF-related ischemic events and misidentification of low-risk patients [ 21 , 22 ]. A recent study showed that only 47% of AF patients were prescribed OACs by primary care doctors, regardless of their CHA 2 DS 2 -VASc score [ 23 ]. Additionally, patients appear to be less sensitive to bleeding risk than doctors [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Low bleeding acceptance is associated with increased death risk in patients with atrial fibrillation on oral anticoagulation

Rusin,

Konieczyńska,

Natorska

et al. 2023

J Thromb Thrombolysis

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Bleeding is the most feared complication of anticoagulation. We sought to investigate whether the bleeding risk acceptance has a prognostic value during long-term follow-up in the era of direct oral anticoagulants (DOACs) among patients with atrial fibrillation (AF). We studied 167 consecutive AF outpatients [aged 68.8 SD 10.6 years; 141 (84.4%) on DOACs]. The bleeding acceptance was assessed based on the Bleeding Ratio defined as the declared maximum number of major bleedings that a patient would be willing to accept to prevent one major stroke. We recorded cerebrovascular ischemic events, major or clinically relevant non-major bleeds (CRNMB), and mortality. A median Bleeding Ratio was 4 (IQR 2–5). During follow-up of 946 patient-years, cerebrovascular ischemic events and/or death were observed in 28 patients (3.3%/ year) and major bleeding or CRNMB in 33 (4.6%/ year). The Bleeding Ratio was lower in patients who experienced cerebrovascular events or death (p = 0.004), but not bleeding. Patients with the Bleeding Ratio 0–3 were more often non-persistent to the OAC therapy, and more likely to have cerebrovascular event or die than those with higher bleeding acceptance (odds ratio 2.55; 0.95% CI 1.08–6.02) which was driven by the impact on mortality. The multiple Cox proportional hazards model showed that lower Bleeding Ratio, higher CHA2DS2-VASc score, and older age predicted cerebrovascular events or death during follow-up. AF patients who are willing to accept fewer serious bleedings to avoid major stroke during anticoagulation are more likely to experience death and/or cerebrovascular ischemic events, but not bleeding, what might be related to non-persistence.

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Factors Correlated with Anticoagulation Choice in Primary Care Patients with Atrial Fibrillation and High Stroke Risk

Weng,

Kuo,

Aho

et al. 2024

J GEN INTERN MED

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Prescribing of anticoagulation for atrial fibrillation in primary care

Cited by 5 publications

References 47 publications

A targeted educational intervention increases oral anticoagulation rates in high-risk atrial fibrillation patients

A targeted educational intervention increases oral anticoagulation rates in high-risk atrial fibrillation patients

Low bleeding acceptance is associated with increased death risk in patients with atrial fibrillation on oral anticoagulation

Factors Correlated with Anticoagulation Choice in Primary Care Patients with Atrial Fibrillation and High Stroke Risk

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