TY - JOUR
AR - JICOA-2019-2-103
TI - Adherence to the Canadian Cardiovascular Society Atrial Fibrillation Guidelines by Family Medicine Groups in Quebec: the I-FACILITER project
AU - Danielle, Dion
AU - Martine, Montigny
AU - Adam, Bobrowski
AU - Isabelle , Greiss
AU - Mark , Roper
AU - Martin, Cadorette
AU - Melinda , Barbaras
AU - Miguel Angel Barrero , Garcia
AU - Pauline , Couture
AU - Robert, Breton
AU - Thao , Huynh
AU - Vincent, Ta
JO - Journal of Integrative Cardiology Open Access
PY - 2019
DA - Tue 02, Jul 2019
SN - 2674-2489
DO - http://dx.doi.org/10.31487/j.JICOA.2019.02.03
UR - https://www.sciencerepository.org/adherence-to-the-canadian-cardiovascular-society-atrial-fibrillation-guidelines-by-family-medicine-groups-in-quebec-the-i-faciliter-project_JICOA-2019-2-103 
KW - Anticoagulation, atrial fibrillation, family medicine, non-vitamin K oral anticoagulants, stroke
AB - 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.