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Can J Cardiol. 2016 Mar;32(3):336-43. doi: 10.1016/j.cjca.2015.07.012. Epub 2015 Oct 15.

The Risk Stratification and Stroke Prevention Therapy Care Gap in Canadian Atrial Fibrillation Patients.

Author information

1
Terrence Donnelly Heart Centre, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
2
Canadian Heart Research Centre, Toronto, Ontario, Canada.
3
St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
4
University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
5
Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
6
Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada.
7
Hôpital Notre-Dame, Université de Montréal, Montreal, Quebec, Canada.
8
Dalhousie University, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada.
9
Montreal Heart Institute, Montreal, Quebec, Canada.
10
Canadian Heart Research Centre, Toronto, Ontario, Canada; LinCorp Medical Inc, Toronto, Ontario, Canada.
11
Terrence Donnelly Heart Centre, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Canadian Heart Research Centre, Toronto, Ontario, Canada. Electronic address: goodmans@chrc.net.

Abstract

BACKGROUND:

Canadian atrial fibrillation (AF) guidelines recommend that all AF patients be risk stratified with respect to stroke and bleeding, and that most should receive antithrombotic therapy.

METHODS:

As part of the Canadian Facilitating Review and Education to Optimize Stroke Prevention in Atrial Fibrillation (FREEDOM AF) chart audit, data were collected on 4670 patients ≥ 18 years old without significant valvular heart disease from the primary care practices of 474 physicians (February to September, 2011).

RESULTS:

Physicians did not provide an estimate of stroke and bleeding risk in 15% and 25% of patients, respectively. When risks were provided, they were on the basis of a predictive stroke and bleeding risk index in only 50% and 26% of patients, respectively. There were over- and underestimation of stroke and bleeding risk in a large proportion of patients. Antithrombotic therapy included warfarin (90%); 24% of patients had a time in the therapeutic range (TTR) < 50%, 9% between 50% and 60%, 11% between 60% and 70%, and 56% had a TTR ≥ 70%.

CONCLUSIONS:

In a large Canadian AF population, primary care physicians did not provide a stroke or bleeding risk in a substantial proportion of their AF patients. When estimates were provided, they were on the basis of a predictive stroke and bleeding risk index in less than half of the patients. Furthermore, there was under- and overestimation of stroke and bleeding risk in a substantial proportion of patients. As many as 1 in 3 patients receiving warfarin have their TTR < 60%. These findings suggest an opportunity to enhance knowledge translation to primary care physicians.

PMID:
26476851
DOI:
10.1016/j.cjca.2015.07.012
[Indexed for MEDLINE]

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