Patient Outcomes According to Adherence to Treatment Guidelines for Rhythm Control of Atrial Fibrillation

Abstract

BackgroundAlthough guidelines for antiarrhythmic drug therapy in atrial fibrillation (AF) were published in 2006, it remains uncertain whether adherence to these guidelines affects patient outcomes.Methods and ResultsWe retrospectively evaluated the records of 5976 consecutive AF patients who were prescribed at least 1 antiarrhythmic drug between 2006 and 2013. Patients with 1 or more prescribed antiarrhythmic drugs that did not comply with guideline recommendations comprised the non–guideline‐directed group (=2920); the remainder constituted the guideline‐directed group (=3056). Time to events was assessed using the survival analysis method and adjusted for covariates using Cox regression. Rates of adherence to the guidelines increased significantly with a higher degree of prescriber specialization in arrhythmias (49%, 55%, and 60% for primary care physicians, general cardiologists, and cardiac electrophysiologists, respectively, P=0.001) for the first prescribed antiarrhythmic drug. Compared to the non–guideline‐directed group, the guideline‐directed group had higher rates of heart failure, but lower baseline CHADS2‐VASc scores (P<0.001) and lower rates of coronary artery disease, valvular disease, hypertension, hyperlipidemia, pulmonary disease, and renal insufficiency (P<0.05 for all). During 45±26 months follow‐up, the guideline‐directed group had a lower risk of AF recurrence (hazard ratio=0.86, 95% CI=0.80 to 0.93), fewer hospital admissions for AF (hazard ratio=0.87, 95% CI=0.79 to 0.97), and fewer procedures for recurrent AF, including electrical cardioversion, pacemaker implantation, and atrioventricular nodal ablation (P<0.01 for all). The mortality and stroke risks were similar between the groups.ConclusionsAdherence to published guidelines in the antiarrhythmic management of AF is associated with improved patient outcomes.

Shared Decision Making Tools for People Facing Stroke Prevention Strategies in Atrial Fibrillation: A Systematic Review and Environmental Scan

“…4 Stroke survivors live with physical and cognitive disabilities, and their families and caregivers often experience social, physical, emotional, and financial difficulties. [5][6][7] Large randomized trials have demonstrated the benefits of anticoagulation in reducing the risk of AF-related strokes, 8 yet many at-risk patients do not receive these benefits [9][10][11] as less than 50% of high-risk patients are treated with anticoagulation therapy 12 and more than 40% discontinue therapy within 12 months. [13][14][15][16][17][18] There are multiple patient-and clinician-associated factors that may lead to underuse of anticoagulants within this population such as inadequate patient/caregiver resources, lack of understanding about risks and benefits, and difficulties with effective communication.…”

The current state of epilepsy guidelines: A systematic review

“…12 For example, a cardiac care study found that when CPG recommendations were followed, patients had lower rates of heart failure, recurrence of atrial fibrillation, and hospitalizations. 13 Unfortunately, this has not necessarily been the experience in epilepsy, 14,15 most likely because of the poor adoption of CPG recommendations into routine clinical practice. [14][15][16][17] Although CPGs can be useful for health professionals and have widespread application beyond the clinical setting, they are not without limitations.…”

“…Regular use of CPGs can improve processes of care and patient outcomes across various disciplines . For example, a cardiac care study found that when CPG recommendations were followed, patients had lower rates of heart failure, recurrence of atrial fibrillation, and hospitalizations . Unfortunately, this has not necessarily been the experience in epilepsy, most likely because of the poor adoption of CPG recommendations into routine clinical practice …”

Impacto en el desenlace funcional en pacientes con ictus: experiencia de una unidad de cuidados neurovasculares

“…10,11 La mejoría en el desenlace funcional puede explicarse porque el ingreso y la estancia en una UCN incluyen la monitorización continua de los signos vitales, resultando en una mayor capacidad para brindar atención oportuna a alteraciones asociadas a desenlaces desfavorables, como arritmias, alteraciones en la presión arterial o incremento en la temperatura. [12][13][14] Además, la admisión a una UCN conlleva un contacto más estrecho con el equipo de profesionales de salud, detectando deterioros clínicos más temprano e incrementando medidas de prevención como la evaluación de la disfagia y la profilaxis de la TVP; además, confiere efectos psicológicos benéficos con un efecto favorable en el desenlace. 15,16 A pesar del incremento en el número de administraciones de aPTr durante el segundo periodo, no hubo diferencia significativa entre ambos periodos.…”