Students Research in Progress
Tuesday, November 14, 2023
08:30 AM–10:00 AM
Abstract
Introduction: Substantial evidence exists that older adults with atrial fibrillation (AF) benefit from prophylaxis for ischemic stroke. The 2019 AHA/ACC/HRS guideline for managing patients with AF recommends using non-vitamin K antagonist oral anticoagulants (NOACs) over warfarin in patients without mitral stenosis or mechanical heart valves. Guideline concordance is not well documented in elderly non-veteran populations and may be influenced by age and comorbidity.
Research Question or Hypothesis: What is the rate of guideline concordance for stroke prevention and the reasons for nonconcordance in an elderly primary care population with AF?
Study Design: Single-center, retrospective chart review.
Methods: Patients >65 years with AF seen in any Nebraska Medicine PCMH clinic between 1/1/22 and 3/31/23 were included. Data elements were extracted from the electronic health record. Descriptive statistics were used to analyze prescribing patterns and guideline concordance. Concordance was determined based on thromboembolic risk (CHA2DS2 VASc), medication class, medication dose, and bleeding risk (HAS-BLED). Chi-square test was used to determine association of treatment regimen with guideline concordance.
Results: The total number of patients included was 1003. The average age was 78.1 years and 50.6% were male. Treatment groups included NOACs (59.0%), warfarin (16.8%), antiplatelet(s) without anticoagulant (8.7%), and no treatment (15.5%). Overall guideline concordance was 57.4% across all groups and 67.9% among groups receiving pharmacologic treatment. Concordance was 90.4% within the NOAC group and 16.0% in the non-NOAC treatment group (p<0.001). The primary reason for non-concordance in the NOAC group was incorrect dose (4.1%). Deviation from first line therapy without cause was the most common reason for nonconcordance in the warfarin (84.6%) and antiplatelet (82.8%) groups.
Conclusion: This study found a modest level of overall guideline concordance for stroke prophylaxis among elderly patients with AF. High concordance was found among patients on NOAC therapy compared to non-NOAC therapy. The most common reason for nonconcordance was deviation from first-line therapy without cause.
Presenting Author
Zackery Rodriguez MPH, PharmD Candidate 2024Department of Pharmacy Practice and Science, College of Pharmacy, University of Nebraska Medical Center
Authors
Donald G. Klepser PhD, MA
UNMC COP
Logan Franck PharmD, BCACP
University of Nebraska Medical Center
Linda Sobeski PharmD
UNMC COP