Adherence to guidelines regarding anticoagulation and risk factors for progression of atrial fibrillation in a nurse‐led clinic

Abstract

Background: Atrial fibrillation (AF) is the commonest cardiac arrhythmia associated with an increased risk of stroke. Evidence suggests that management in a specialty clinic improves clinical outcomes of patients. Aims: To assess level of adherence to evidence-based guidelines regarding anticoagulation and the risk factors for progression of AF in a nurse-led AF clinic. Methods: A retrospective analysis was conducted on clinical records of 136 patients seen at the AF clinic to determine their risk factors and progression of AF (change in AF type to more advanced types) during follow up. Additionally, the proportion of patients with CHA 2 DS 2 -VASC score (congestive heart failure, hypertension, age ≥75 (doubled), diabetes mellitus, stroke (doubled)-vascular disease, age 65-74 years, sex category (female)) of ≥2 who were prescribed anticoagulants according to European Society of Cardiology guidelines before and after attending the clinic was determined. Results: Rate of anticoagulation in patients with CHA 2 DS 2 -VASC score of ≥2 after attending the clinic (91.3%) was significantly higher than the rate before attending the clinic (79.3%) (P = 0.0076). Mean age in those with AF progression (72.5 AE 9.4) was higher than those without AF progression (66.9 AE 13.9) (P = 0.0072). Rate of AF progression was higher in those with obesity (body mass index ≥30 kg/m 2 ) (P = 0.0364) and those with excessive alcohol intake (>2 standard drinks) (P = 0.0039). History of hypertension was not a significant predictor of AF progression (P = 0.7507). Conclusions: Management of AF in a nurse-led clinic was associated with high level of adherence to anticoagulation guidelines. Age, obesity and excessive alcohol intake were significant predictors for progression of AF.

Non-adherence to Thromboprophylaxis Guidelines in Atrial Fibrillation: A Narrative Review of the Extent of and Factors in Guideline Non-adherence

“…[71] Of note, findings from all of these retrospective studies suggest that studies with lower sample size my underestimate the proportion of patients receiving undertreatment. [18,43,57,69] With the exception of the nurse-led clinic [71], an increasing trend in the proportion of patients receiving undertreatment was observed with increasing sample size. [18,43,57,69]…”

A nurse‐led atrial fibrillation clinic: Impact on anticoagulation therapy and clinical outcomes

“…However, adherence to guideline recommendations is higher when nurses are involved in the AF clinic and this could be related with better clinical outcomes 39. For example, a recent retrospective study found that the management of AF in a nurse-led clinic was associated with high level of adherence to anticoagulation guidelines 40. Also, an integrated specialised nurse-driven, physician supervised AF clinic demonstrated to reduce all-cause mortality compared with usual care 41.…”

Evaluation of the effectiveness of a mobile application on the adherence of patients with atrial fibrillation

“…In addition to age, among other risk factors for the development of cardiovascular pathology, the presence of excess weight in patients has been identified as a significant risk factor for the progression of AF [38]. Perhaps for this reason, participants in the IG group, due to their higher adherence to treatment, had a statistically significant lower number of overweight patients compared to participants in the CG group.…”