Abstract 11550: Underutilization of Anticoagulation for Stroke Prevention among 5,000 Consecutive Hospitalized Atrial Fibrillation Patients
Introduction: Failure to prevent stroke in patients with atrial fibrillation (AF) has become an increasingly important patient safety concern.
Hypothesis: We hypothesized that anticoagulation would be underutilized in hospitalized patients with AF at our tertiary care referral center.
Methods: 5,000 consecutive patients hospitalized at Brigham and Women’s Hospital between May 2008 and September 2014 with nonvalvular AF were identified and evaluated.
Results: All-cause mortality at 90 days was 5.4%. The frequencies of death between hospital discharge and Day 90 were higher in patients who were not prescribed anticoagulation at discharge (7.1% vs. 2.8%, p < 0.0001). Anticoagulation prescription at discharge was associated with a 60% reduction in death between discharge and Day 90, after adjustment for confounding factors. Anticoagulation was prescribed at discharge to 61.6% of patients with a CHA2DS2-VASc score of at least 1 (Figure). The most frequent reasons for omitting anticoagulation were bleeding risk and peri-operative state.
Conclusions: Prescription of anticoagulation was lower than expected in patients with AF during hospitalization and at discharge. Patients with AF who were not prescribed anticoagulation at discharge had an increased risk of death at 90 days.
Author Disclosures: G. Piazza: Research Grant; Modest; BMS/Pfizer, Daiichi-Sankyo. Research Grant; Significant; Janssen. S. Hurwitz: None. L. Harrigan: None. K. Jenkins: None. B. Hohlfelder: None. J. Fanikos: Consultant/Advisory Board; Modest; Boehringer Ingelheim. G.Z. Samuel: Research Grant; Modest; Janssen. Research Grant; Significant; BMS-Pfizer Alliance, Daiichi-Sankyo, Boehringer Ingelheim. Consultant/Advisory Board; Significant; Portola.
- © 2016 by American Heart Association, Inc.