Implementing hospital guidelines improves warfarin use in non-valvular atrial fibrillation: a before-after study

• Main Authors: Piobbici Marina (Author), Boscolo Daniela (Author), Scaglione Luca (Author), Valpreda Susanna (Author), Bo Simona (Author), Bo Mario (Author), Ciccone Giovannino (Author)
• Format: Book
• Published: BMC, 2007-08-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.
• Notes: 10.1186/1471-2458-7-203; 1471-2458
• Keywords: Public aspects of medicine; RA1-1270
• Source: BMC Public Health, Vol 7, Iss 1, p 203 (2007)

<p>Abstract</p> <p>Background</p> <p>The use of oral anticoagulant therapy (OAT) to prevent non-valvular atrial fibrillation (NVAF) related-strokes is often sub-optimal. We aimed to evaluate whether implementing guidelines on antithrombotic therapy (AT) by a multifaceted strategy may improve appropriateness of its prescription in NVAF-patients discharged from a large tertiary-care hospital.</p> <p>Methods</p> <p>A survey was conducted on all consecutive NVAF patients discharged before (1^stJanuary-30^thJune 2000, <it>n </it>= 313) and after (1^stJanuary-30^thJune 2004, <it>n </it>= 388) guideline development and implementation.</p> <p>Results</p> <p>When strongly recommended, OAT use increased from 56.6% (60/106 in 2000) to 81.9% (86/105 in 2004), with an absolute difference of +25.3% (95%CI: 15% 35%). In patients for whom the choice OAT/acetylsalicylic acid should be individualised, those discharged without any AT were 33.7% (34/101) in 2000 and 16.9% (21/124) in 2004 (-16.7%;95%CI: -26.2% -7.2%). In a logistic regression model, OAT prescription in 2004 was increased by 2.11 times (95%CI: 1.47 3.04), after accounting for stroke risk, presence of contraindications (OR = 0.18; 0.13 0.27), older age (OR = 0.30; 0.21 0.45), prophylaxis at admission (OR = 3.03; 2.08 4.43). OAT was positively associated with the stroke risk in the 2004 sample only.</p> <p>Conclusion</p> <p>The guideline implementation has substantially improved the appropriateness of OAT at discharge, through a better evaluation at patient's individual level of the benefit-to-risk ratio.</p>