Abstract 8440: Guideline Recommended Evaluation in Patients with a First Episode of Atrial Fibrillation
Background: In patients with a first episode of atrial fibrillation (AF), current guidelines specifically recommend assessment of cardiac function, valvular and ischemic heart disease, and thyroid, kidney, and liver function. We assessed the completion of guideline recommended evaluations among 244,921 patients with a new diagnosis of AF.
Methods and Results: We studied commercially insured patients from MarketScan, aged 18-64 years (n=40,245), and a 5% nationally representative cohort of Medicare beneficiaries ≥65 years (n=204,676). All patients were first diagnosed with AF between 2000-2008. We used claims data to assess completion of guideline recommended physician visits and examinations, electrocardiograms, echocardiograms, and laboratory tests for thyroid, renal and liver function. From 2004-2007, evaluation rates increased. By 2007, all guideline recommended evaluations were completed in 17.4% of the MarketScan sample and 18.5% of the Medicare cohort (Figure). Almost all patients received electrocardiograms, and two-thirds of patients received an echocardiogram. In 2007, laboratory testing for thyroid function was performed in 31.7% of patients in the MarketScan and 34.2% in Medicare. Stratification by sex (Figure), race, or geographic region revealed only minor differences in the completeness of evaluation. Evaluation rates were stable across age groups as well (Figure), except for nonagenarians, where the rate of completed evaluation averaged across the observation period was 9.5%.
Conclusion: In this large nationally representative study covering a wide age-range, the completion rate of guideline-recommended evaluation following a new diagnosis of AF was low. Except for nonagenarians, the evaluation completion rate varied only marginally with age, sex, race and geographic region.
Figure: Increase of completed evaluation over time. Left: MarketScan; right: Medicare. Above: stratified by sex; Below: stratified by age groups.
- © 2011 by American Heart Association, Inc.