Abstract 20047: Assessing the Utilization of CHA2DS2-VASc Score in Patients With Atrial Fibrillation and its Impact on the Use of Anticoagulation
Introduction: Stroke is a well-known complication of atrial fibrillation (AF), often causing severe disability in patients and accounting for significant healthcare costs. Even with advances in anticoagulation with the introduction of novel oral anticoagulants (NOAC), and easy-to-use validated risk stratification tools, such as the CHA2DS2-VASc score, the rate of appropriate anticoagulation remains low.
Methods: Retrospective analysis of 1,200 randomly selected charts of patients with AF receiving care in a community based teaching hospital, located in northeastern Illinois, between 2012 and 2015.
Results: Of the 1,200 patients, 14% had a CHA2DS2-VASc score documented in their chart. Excluding the 14 patients (1.2%) who refused anticoagulation treatment, the use of anticoagulation was higher among patients with CHA2DS2-VASc score documentation vs no documentation (68.5% vs 59%, p=0.02). There was a statistically significant reduction in the documentation of this scoring method from 20.3% in 2012 to 10.3% in 2015 (p=0.003). However, the percent of appropriately treated patients did not differ significantly over time (p=0.17). Sixty percent of patients who met criteria for anticoagulation based on the 2014 American College of Cardiology/American Heart Association guidelines were appropriately treated with anticoagulation, compared to 18.8% who did not receive any anticoagulation and had no documentation of reason for withholding. Of the 20.4% of patients with a relative or absolute contraindication for anticoagulation, a history of falls was the most frequently cited reason (21.9%) and a positive and statistically significant correlation was observed for not receiving anticoagulation (p<0.0001). Although not statistically significant, patients who received anticoagulation also tended to be younger (78 ± 11 vs 80 ± 13, p=0.57).
Conclusions: A significant number of patients who meet criteria for anticoagulation are not receiving proper treatment despite risk assessment tools and simple dosing regimens with NOAC agents. Quality improvement measures should be formulated and implemented to improve proper assessment and treatment in patients with atrial fibrillation who require anticoagulation for stroke prevention.
Author Disclosures: H. Patel: None. J. Park: None. D. Johnson: None. S. Sulo: None. S. Kozmic: None. F. Dabbous: None. S.T. Smith: None. A.S. Brown: None.
- © 2016 by American Heart Association, Inc.