Adherence to the Canadian Cardiovascular Society Atrial Fibrillation Guidelines by Family Medicine Groups in Quebec: the I-FACILITER project

Adherence to the Canadian Cardiovascular Society Atrial Fibrillation Guidelines by Family Medicine Groups in Quebec: the I-FACILITER project

Author Info

Corresponding Author
Thao Huynh
Division of Cardiology, Department of Medicine, McGill Health University Center

A B S T R A C T

Background: The Canadian Cardiovascular Society (CCS) Atrial Fibrillation (AF) guidelines 2014 recommends oral anticoagulation (OAC) for patients with CHADS2 ≥1 or age ≥65 years and non-vitamin K oral anticoagulants (NOAC)s as the preferred medications. We aimed to evaluate adherence to these guidelines by family group practices (FMG) in Quebec. Methods and results: We completed a cross-sectional evaluation at 15 FMGs. There were 431 patients with non-valvular AF: mean age of 77.3±10.4 years and 52.9% were females. CHADS2 and HAS-BLED were infrequently documented (47% and 7%, respectively). Most patients (93%) were appropriately anticoagulated (96% for both patients with CHADS2 ≥1 and patients with age ≥65 years). Sixty-five percent of patients were anticoagulated with warfarin, 28% with NOACs and 21% of patients received a combination of oral anticoagulant (OAC)s and aspirin. Every decade increase in age was associated with 49% increase in odds of adherence to the guidelines and 26% decrease in odds of NOACs’s use. Each point increase in HAS-BLED was associated with 51% decrease in odds of adherence to the guidelines and 36% decrease in odds of NOACS’s use. No patient with HAS-BLED of ≥5 received NOAC. Heart failure was associated with a 61% decrease in odds of NOACS’s use. Conclusion: AF management by FMGs could be improved by 1) increasing NOACs uptake, 2) decreasing the combination of OAC with ASA and 3) increasing documentation of stroke and bleeding risks.

Article Info

Article Type
Research Article
Publication history
Received: Mon 03, Jun 2019
Accepted: Fri 14, Jun 2019
Published: Tue 02, Jul 2019
Copyright
© 2023 Thao Huynh. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Hosting by Science Repository.
DOI: 10.31487/j.JICOA.2019.02.03