Abstract Number: PB2079
Meeting: ISTH 2020 Congress
Background: Oral anticoagulant (OAC) therapy is a cornerstone of thromboembolic (TE) prevention in patients with atrial fibrillation (AF). A significant lack of OAC prescription to reduce TE risk across the U.S. has been described in the PINNACLE and ORBIT AF registries. Both registries use data from electronic medical records (EMR).
Aims: Understand if EMR diagnostic code data reflects the true clinical appropriateness of OAC therapy prescribing practice for nonvalvular AF patients.
Methods: A health data warehouse at our institution provided a list of patients ≥ 18 years old, enrolled in two primary care clinics from January 2012 until June 2019 who had a diagnostic code for nonvalvular AF in our EMR. A retrospective chart review was performed for each patient. Based on available documentation, iterative exclusions were made, which left a cohort of AF patients with a Class I indication (2019 AHA/ACC/HRS Focused Update) for anticoagulation (AC). Descriptive statistics (number and percentage) were reported for the baseline and Class I cohorts.
Results: The baseline cohort included 1,204 AF patients for review. Only 63% (n=763) were prescribed OAC therapy. Seven clinically relevant exclusions were made (n=390), which left 814 AF patients with a Class I indication for anticoagulation (see table). After exclusions, 93.7% of AF patients were prescribed OAC therapy. Documented reasons for withholding anticoagulation in AF patients with a Class I indication were aspirin substituted for anticoagulation (n=9), minor bleeding (n=5), OAC therapy recommended but not prescribed (n=4), and a CHA₂DS₂-VASc score that increased following time of documentation (n=4) (see figure).
Conclusions: Registries that use EMR data may underestimate the true performance of health system adherence to guideline recommended anticoagulation prescribing practice for patients with nonvalvular AF.
|Documented Reasons Excluded||# Excluded||N||# Not Prescribed OAC||% Prescribed OAC|
|No longer receives care at our institution||65||1,059||296||72%|
|Has left atrial occlusion device (WATCHMAN), or a documented discussion about implantation||32||1,027||264||74.3%|
|Major event or severely elevated bleeding risk (CNS or gastrointestinal bleed, HASBLED ≥ 5)||31||996||233||76.6%|
|Resolved AF (single episode > 1 yr ago, reversible cause, post ablation & followed by EP, post-operative AF, or heart transplant)||74||922||159||82.7%|
|Low CHA₂DS₂-VASc Score (female ≤ 2, male ≤ 1)||86||836||73||91.3%|
[Iterative Percentage of AF Patients Prescribed Anticoagulation Following Relevant Exclusions.]
To cite this abstract in AMA style:Woodhouse G, Paschall Z, Lunowa C, Burch J, Schilling L, Rosenberg M, Mantini N. Beyond the Registry: A Nuanced Evaluation of Real World Anticoagulation for Nonvalvular Atrial Fibrillation Patients at a Tertiary Care Center [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/beyond-the-registry-a-nuanced-evaluation-of-real-world-anticoagulation-for-nonvalvular-atrial-fibrillation-patients-at-a-tertiary-care-center/. Accessed May 18, 2021.
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