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A Survey of Concordance of Anticoagulant Therapy Administration in Atrial Fibrillation According to Guidelines: A Secondary Care Center Experience

Year 2013, Volume: 18 Issue: 4, 203 - 207, 01.08.2013

Abstract

Objective: Atrial fibrillation (AF) is the most prevalent permanent rhythm disturbance. For the diagnosis and treatment of AF numerous guidelines have been published. The data about implementation of risk calculation table (CHA2DS2-VASC score) which was suggested by European Society of Cardiology (ESC) for prevention of stroke is very limited. Our aim was to document the data about implementation of guidelines and CHA2DS2-VASC score in AF treatment by cardiology specialists. Material and Method: The patients who were following up with diagnosis of AF that were admitted to cardiology outpatient units in 2012 were retrospectively included into present study. With registration of clinical and demographic properties of patients CHA2DS2-VASC scores and treatment applications were investigated. According to the result of International Normalized Ratio (INR) workup at last 1 year, the success of anticoagulant therapy was evaluated. Results: In the year of 2012 among 2303 patients who were admitted to cardiology outpatient clinic, 137 (6.2%) patients were diagnosed with AF. Of 128 patients that were recruited to study, 83 (64.8%) were women. Mean age was 67,5±10,9 years. Mean CHA2DS2-VASC score was found 3,36±1,77. Among 108 patients whose CHA2DS2-VASC was ≥2 and who have to use anticoagulant therapy, 71 (65.7%) patients were using warfarine and 1 (0.9%) was using rivoraxaban. Sixty six patients (51.6 %) were using acetylsalicilic acid. Even though warfarine was initiated, discontinuation rate of treatment was 10.2%. According to retrospective evaluation of INR levels, it was seen that in 71.1% of patients theraupetic targets were established. Conclusion: Data of patients who were following up and treated with diagnosis of AF in cardiology outpatient clinic showed that ESC guidelines were taken into consideration, but difficulty in follow up of warfarine efficacy and concerns about drug-food interactions lead important number of patients not to use oral anticoagulation, but instead lead them to use acetilysalicilic acid in higher rates of guideline suggestions.

References

  • Stewart S, Hart CL, Hole DJ, McMurray JJ. Population prevalence, incidence, and predictors of atrial fibrillation in the Renfrew/Paisley study. Heart 2001; 86: 516-21.
  • Go AS, Hylek EM, Phillips KA, et al. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA 2001; 285: 2370-5.
  • European Heart Rhythm Association; European Association for Cardio-Thoracic Surgery, Camm AJ, Kirchhof P, Lip GY, et al. Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J 2010; 31: 2369-429.
  • Conway DS, Pearce LA, Chin BS, Hart RG, Lip GY. Prognostic value of plasma von Willebrand factor and soluble Pselectin as indices of endothelial damage and platelet activation in 994 patients with nonvalvular atrial fibrillation. Circulation 2003; 107: 3141-5.
  • Akyol A. Atriyal Fibrilasyonda Antitrombotik Kullanım Endikasyonları. Trakya Univ Tip Fak Derg 2010; 27: 1-6.
  • Gage BF, Waterman AD, Shannon W, Boechler M, Rich MW, Radford MJ. Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation. JAMA 2001; 285: 2864-70.
  • Lip GY, Nieuwlaat R, Pisters R, Lane DA, Crijns HJ. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the Euro Heart Survey on atrial fibrillation. Chest 2010; 137: 263-72.
  • Lang RM, Bierig M, Devereux RB, et al; Chamber Quantification Writing Group; American Society of Echocardiography’s Guidelines and Standards Committee; European Association of Echocardiography. Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 2005; 18: 1440-63.
  • Özdemir M. Avrupa Kardiyoloji Derneği’nin atriyum fibrilasyonuna yaklaşım kılavuzunun 2012 güncellemesi. Türk Kardiyol Dern Arş 2012; 40: 659-62.
  • Maisel WH, Stevenson LW. Atrial fibrillation in heart failure: epidemiology, pathophysiology and rationale for therapy. Am J Cardiol 2003; 91: 2-8.
  • Banerjee A, Taillandier S, Olesen J B, et al. Ejection fraction and outcomes in patients with atrial fibrillation and heart failure: the Loire Valley Atrial Fibrillation Project. Eur J Heart Fail 2012; 14: 295-301.
  • Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke 1991; 22: 983-8.
  • Healey JS, Connolly SJ. Atrial Fibrillation: Hypertension as a Causative Agent, Risk Factor for Complications, and Potential Therapeutic Target. Am J Cardiol 2003; 91: 9-14
  • Atrial Fibrillation Investigators Risk factors for stroke and efficacy of antithrombotic therapy in atrial fibrillation. Analysis of pooled data from five randomized controlled trials, Arch Intern Med 1994; 154: 1449-57.
  • Miyasaka Y, Barnes ME, Gersh BJ, et al. Secular trends in incidence of atrial fibrillation in Olmsted County, Minnesota, 1980 to 2000, and implications on the projections for future prevalence. Circulation 2006; 114: 119-25.
  • Lip GYH, Rudolf M. The new NICE guideline on atrial fibrillation management. Heart 2007: 93: 23.
  • Fuster V, Ryden LE, Cannom DS, et al. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation). J Am Coll Cardiol 2006: 48; 854-906.
  • Uyarel H, Onat A, Yüksel H, Can G, Ordu S, Dursunoğlu D. Incidence, prevalence, and mortality estimates for chronic atrial fibrillation in Turkish adults. Türk Kardiyol Dern Arş 2008; 36: 214-22.
  • Karaçağlar E, Atar İ, Yetiş B, et al. Atriyal fibrilasyon hastalarında emboli risk faktörleri sıklığı ve emboli önleyici tedavilerin uygunluğunun araştırılması: Tek üçüncül bir merkez deneyimi. Anadolu Kardiyol Derg 2012; 12: 384-90.
  • Daniel E, Singer Alan S, Go A. New Era in Stroke Prevention for Atrial Fibrillation Comment on Current Trial-Associated Outcomes With Warfarin in Prevention of Stroke in Patients With Nonvalvular Atrial Fibrillation Arch Intern Med 2012; 172: 631-3.
  • Gallagher MM, Camm AJ. Long-term management of atrial fibrillation. Clin Cardiol 1997; 20: 381-90.
  • Alam M, Bandeali SJ, Shahzad SA, Lakkis N. Real-life global survey evaluating patients with atrial fibrillation (REALISEAF): results of an international observational registry. Expert Rev Cardiovasc Ther 2012; 10: 283-91.
  • Petersen P, Boysen G, Godtfredsen J, Andersen ED, Andersen B. Placebo controlled, randomised trial of warfarin and aspirin for prevention of thromboembolic complications in chronic atrial fibrillation: the Copenhagen AFASAK Study. Lancet 1989; 1: 175-79.
  • Connolly SJ, Laupacis A, Gent M, Roberts RS, Cairns JA, Joyner C. CAFA Study Co-Investigators. Canadian Atrial Fibrillation Anticoagulation (CAFA) Study. J Am Coll Cardiol 1991; 18: 349-55.
  • Rash A, Downes T, Portner R, Yeo WW, Morgan N, Channer K. A randomised controlled trial of warfarin versus aspirin for stroke prevention in octogenarians with atrial fibrillation (WASPO). Age Ageing 2007; 36: 151-6.

Atrial Fibrilasyonda Pıhtı Önleyici Tedavi Uygulamalarında Kılavuzlara Uygunluğun Araştırılması: İkincil Merkez Deneyimi

Year 2013, Volume: 18 Issue: 4, 203 - 207, 01.08.2013

Abstract

Amaç: Atrial fibrilasyon (AF) en sık görülen kalıcı ritim bozukluğudur. AF tanı ve tedavisi için bir çok kılavuz yayınlanmıştır. İnmenin önlenmesi için Avrupa Kardiyoloji Derneği (ESC) tarafından önerilen risk hesaplama tablosunun (CHA2DS2-VASC skoru) uygulanmasıyla ilgili veriler oldukça sınırlıdır. Amacımız AF tedavisinde kılavuzların ve CHA2DS2-VASC skorunun kardiyoloji uzmanları tarafından uygulamasına ait verileri ortaya koymaktır. Gereç ve Yöntem: Retrospektif olarak 2012 yılı içinde kardiyoloji polikliniğinde AF tanısıyla takip edilen hastalar çalışmaya alındı. Hastaların klinik ve demografik özellikleri kaydedilerek CHA2DS2-VASC skoru ve uygulanan tedaviler incelendi. Bir yıl içinde yapılan International Normalized Ratio (INR) tetkik sonuçlarına göre pıhtı önleyici tedavinin başarı durumu değerlendirildi. Bulgular: 2012 yılında kardiyoloji polikliniğine başvuran 2303 hastanın 137 (%6,2)'sine AF tanısı konuldu. Çalışmaya alınan 128 hastanın 83'ü (%64,8) kadındı. Yaş ortalaması 67,5±10,9 yıldı. Ortalama CHA2DS2-VASC skoru 3,36±1,77 bulundu. CHA2DS2-VASC skoru ≥2 olup mutlak olarak pıhtı önleyici kullanması gereken 108 hastadan 71 (%65,7) hasta varfarin ve 1 (%0,9) hasta rivaroksaban kullanmaktaydı. Hastaların 66 (%51,6)'sı aspirin kullanmaktaydı. Varfarin başlandığı halde tedaviyi bırakma oranı %10,2 bulundu. Retrospektif olarak incelenen İNR değerleri, hastaların %71,1'inde terapotik hedefinin sağlandığı görüldü. Sonuç: Kardiyoloji polikliniğinde AF tanısıyla takip ve tedavi edilen hastaların verileri, ESC kılavuzunun dikkate alındığını, ancak varfarin etkinliği takibinin zorluğu ve ilaç-gıda etkileşimi gibi çekinceler nedeniyle önemli oranda hastanın oral antikoagülan kullanmayıp bunun yerine kılavuzda önerilenden daha fazla oranda aspirin kullandığı tesbit edildi.

References

  • Stewart S, Hart CL, Hole DJ, McMurray JJ. Population prevalence, incidence, and predictors of atrial fibrillation in the Renfrew/Paisley study. Heart 2001; 86: 516-21.
  • Go AS, Hylek EM, Phillips KA, et al. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA 2001; 285: 2370-5.
  • European Heart Rhythm Association; European Association for Cardio-Thoracic Surgery, Camm AJ, Kirchhof P, Lip GY, et al. Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J 2010; 31: 2369-429.
  • Conway DS, Pearce LA, Chin BS, Hart RG, Lip GY. Prognostic value of plasma von Willebrand factor and soluble Pselectin as indices of endothelial damage and platelet activation in 994 patients with nonvalvular atrial fibrillation. Circulation 2003; 107: 3141-5.
  • Akyol A. Atriyal Fibrilasyonda Antitrombotik Kullanım Endikasyonları. Trakya Univ Tip Fak Derg 2010; 27: 1-6.
  • Gage BF, Waterman AD, Shannon W, Boechler M, Rich MW, Radford MJ. Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation. JAMA 2001; 285: 2864-70.
  • Lip GY, Nieuwlaat R, Pisters R, Lane DA, Crijns HJ. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the Euro Heart Survey on atrial fibrillation. Chest 2010; 137: 263-72.
  • Lang RM, Bierig M, Devereux RB, et al; Chamber Quantification Writing Group; American Society of Echocardiography’s Guidelines and Standards Committee; European Association of Echocardiography. Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 2005; 18: 1440-63.
  • Özdemir M. Avrupa Kardiyoloji Derneği’nin atriyum fibrilasyonuna yaklaşım kılavuzunun 2012 güncellemesi. Türk Kardiyol Dern Arş 2012; 40: 659-62.
  • Maisel WH, Stevenson LW. Atrial fibrillation in heart failure: epidemiology, pathophysiology and rationale for therapy. Am J Cardiol 2003; 91: 2-8.
  • Banerjee A, Taillandier S, Olesen J B, et al. Ejection fraction and outcomes in patients with atrial fibrillation and heart failure: the Loire Valley Atrial Fibrillation Project. Eur J Heart Fail 2012; 14: 295-301.
  • Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke 1991; 22: 983-8.
  • Healey JS, Connolly SJ. Atrial Fibrillation: Hypertension as a Causative Agent, Risk Factor for Complications, and Potential Therapeutic Target. Am J Cardiol 2003; 91: 9-14
  • Atrial Fibrillation Investigators Risk factors for stroke and efficacy of antithrombotic therapy in atrial fibrillation. Analysis of pooled data from five randomized controlled trials, Arch Intern Med 1994; 154: 1449-57.
  • Miyasaka Y, Barnes ME, Gersh BJ, et al. Secular trends in incidence of atrial fibrillation in Olmsted County, Minnesota, 1980 to 2000, and implications on the projections for future prevalence. Circulation 2006; 114: 119-25.
  • Lip GYH, Rudolf M. The new NICE guideline on atrial fibrillation management. Heart 2007: 93: 23.
  • Fuster V, Ryden LE, Cannom DS, et al. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation). J Am Coll Cardiol 2006: 48; 854-906.
  • Uyarel H, Onat A, Yüksel H, Can G, Ordu S, Dursunoğlu D. Incidence, prevalence, and mortality estimates for chronic atrial fibrillation in Turkish adults. Türk Kardiyol Dern Arş 2008; 36: 214-22.
  • Karaçağlar E, Atar İ, Yetiş B, et al. Atriyal fibrilasyon hastalarında emboli risk faktörleri sıklığı ve emboli önleyici tedavilerin uygunluğunun araştırılması: Tek üçüncül bir merkez deneyimi. Anadolu Kardiyol Derg 2012; 12: 384-90.
  • Daniel E, Singer Alan S, Go A. New Era in Stroke Prevention for Atrial Fibrillation Comment on Current Trial-Associated Outcomes With Warfarin in Prevention of Stroke in Patients With Nonvalvular Atrial Fibrillation Arch Intern Med 2012; 172: 631-3.
  • Gallagher MM, Camm AJ. Long-term management of atrial fibrillation. Clin Cardiol 1997; 20: 381-90.
  • Alam M, Bandeali SJ, Shahzad SA, Lakkis N. Real-life global survey evaluating patients with atrial fibrillation (REALISEAF): results of an international observational registry. Expert Rev Cardiovasc Ther 2012; 10: 283-91.
  • Petersen P, Boysen G, Godtfredsen J, Andersen ED, Andersen B. Placebo controlled, randomised trial of warfarin and aspirin for prevention of thromboembolic complications in chronic atrial fibrillation: the Copenhagen AFASAK Study. Lancet 1989; 1: 175-79.
  • Connolly SJ, Laupacis A, Gent M, Roberts RS, Cairns JA, Joyner C. CAFA Study Co-Investigators. Canadian Atrial Fibrillation Anticoagulation (CAFA) Study. J Am Coll Cardiol 1991; 18: 349-55.
  • Rash A, Downes T, Portner R, Yeo WW, Morgan N, Channer K. A randomised controlled trial of warfarin versus aspirin for stroke prevention in octogenarians with atrial fibrillation (WASPO). Age Ageing 2007; 36: 151-6.
There are 25 citations in total.

Details

Primary Language Turkish
Journal Section Articles
Authors

Abdulmelik Yıldız This is me

Cennet Yıldız This is me

Publication Date August 1, 2013
Published in Issue Year 2013 Volume: 18 Issue: 4

Cite

APA Yıldız, A., & Yıldız, C. (2013). Atrial Fibrilasyonda Pıhtı Önleyici Tedavi Uygulamalarında Kılavuzlara Uygunluğun Araştırılması: İkincil Merkez Deneyimi. Fırat Tıp Dergisi, 18(4), 203-207.
AMA Yıldız A, Yıldız C. Atrial Fibrilasyonda Pıhtı Önleyici Tedavi Uygulamalarında Kılavuzlara Uygunluğun Araştırılması: İkincil Merkez Deneyimi. Fırat Tıp Dergisi. August 2013;18(4):203-207.
Chicago Yıldız, Abdulmelik, and Cennet Yıldız. “Atrial Fibrilasyonda Pıhtı Önleyici Tedavi Uygulamalarında Kılavuzlara Uygunluğun Araştırılması: İkincil Merkez Deneyimi”. Fırat Tıp Dergisi 18, no. 4 (August 2013): 203-7.
EndNote Yıldız A, Yıldız C (August 1, 2013) Atrial Fibrilasyonda Pıhtı Önleyici Tedavi Uygulamalarında Kılavuzlara Uygunluğun Araştırılması: İkincil Merkez Deneyimi. Fırat Tıp Dergisi 18 4 203–207.
IEEE A. Yıldız and C. Yıldız, “Atrial Fibrilasyonda Pıhtı Önleyici Tedavi Uygulamalarında Kılavuzlara Uygunluğun Araştırılması: İkincil Merkez Deneyimi”, Fırat Tıp Dergisi, vol. 18, no. 4, pp. 203–207, 2013.
ISNAD Yıldız, Abdulmelik - Yıldız, Cennet. “Atrial Fibrilasyonda Pıhtı Önleyici Tedavi Uygulamalarında Kılavuzlara Uygunluğun Araştırılması: İkincil Merkez Deneyimi”. Fırat Tıp Dergisi 18/4 (August 2013), 203-207.
JAMA Yıldız A, Yıldız C. Atrial Fibrilasyonda Pıhtı Önleyici Tedavi Uygulamalarında Kılavuzlara Uygunluğun Araştırılması: İkincil Merkez Deneyimi. Fırat Tıp Dergisi. 2013;18:203–207.
MLA Yıldız, Abdulmelik and Cennet Yıldız. “Atrial Fibrilasyonda Pıhtı Önleyici Tedavi Uygulamalarında Kılavuzlara Uygunluğun Araştırılması: İkincil Merkez Deneyimi”. Fırat Tıp Dergisi, vol. 18, no. 4, 2013, pp. 203-7.
Vancouver Yıldız A, Yıldız C. Atrial Fibrilasyonda Pıhtı Önleyici Tedavi Uygulamalarında Kılavuzlara Uygunluğun Araştırılması: İkincil Merkez Deneyimi. Fırat Tıp Dergisi. 2013;18(4):203-7.