Poor Outcomes Associated with Antithrombotic Potential Undertreatment in Patients with Atrial Fibrillation: A Retrospective Cohort Study

• Published in: Value in health 2017-10, Vol.20 (9), p.A625-A626
• Main Authors: Gebreyohannes, EA, Tegegn, HG, Bhagavathula, AS
• Format: Article
• Language: English
• Subjects: Atrial fibrillation; Bleeding; Cardiac arrhythmia; Censuses; Clinical outcomes; Cohort analysis; Drugs; Fibrillation; Ischemia; Management development programmes; Medical records; Mortality; Multivariate analysis; Statistical analysis; Stroke; Transient ischemic attack
• ISSN: 1098-3015; 1524-4733
• DOI: 10.1016/j.jval.2017.08.1377

OBJECTIVES: To measure the adequacy of antithrombotic medication use and to investigate the impact of potential antithrombotic undertreatment, on ischemic stroke and/or all-cause mortality in patients with AF. METHODS: The study was conducted from January 7,2016 to April 30 2017 at Gondar University Hospital (GUH). A census using a retrospective cohort study design was conducted on medical records of patients with AF attending GUH between November 2012 and September 2016. Descriptive statistics were used to summarize baseline information. Patients receiving appropriate antithrombotic management and those on potential undertreatment, were followed for development of ischemic stroke and/or all-cause mortality. Kaplan-Meier and a log-rank test was used to plot the survival analysis curve. Cox regression was used to determine the predictors of guideline-adherent antithrombotic therapy. RESULTS: The final analysis included 159 AF patients with a median age of 60 years. Of these, nearly two third (64.78%) of patients were receiving potential undertreatment for antithrombotic medications. Upon multivariate analysis, history of ischemic stroke/transient ischemic attack (TIA) was associated with lower incidence of antithrombotic potential undertreatment. A significant increase (HR: 8.194, 95% CI: 2.911-23.066)] in the incidence of ischemic stroke and/or all-cause mortality was observed in patients with potential undertreatment. Up-on multivariate analysis, only increased age was associated with a statistically significant increase incidence of ischemic stroke and/or all-cause mortality, while only history of ischemic stroke/TIA was associated with a decrease in the risk of ischemic stroke and/or all-cause mortality. CONCLUSIONS: Adherence to antithrombotic guideline recommendations was found to be crucial in reducing the incidence of ischemic stroke and/or all-cause mortality in patients with AF without increasing the risk of bleeding. However, potential undertreatment to antithrombotic medications was found to be high (64.78%) and was associated with poorer outcomes in terms of ischemic stroke and/or all-cause mortality (HR: 8.194,95% CI: 2.911-23.066).