The Risk Stratification and Stroke Prevention Therapy Care Gap in Canadian Atrial Fibrillation Patients

Paul Angaran; Paul Dorian; Mary K. Tan; Charles R. Kerr; Martin S. Green; David J. Gladstone; L. Brent Mitchell; Carl Fournier; Jafna L. Cox; Mario Talajic; Peter J. Lin; Anatoly Langer; Lianne Goldin; Shaun G. Goodman

doi:10.1016/j.cjca.2015.07.012

The Risk Stratification and Stroke Prevention Therapy Care Gap in Canadian Atrial Fibrillation Patients

Paul Angaran, Paul Dorian, Mary K. Tan, Charles R. Kerr, Martin S. Green, David J. Gladstone, L. Brent Mitchell, Carl Fournier, Jafna L. Cox, Mario Talajic, Peter J. Lin, Anatoly Langer, Lianne Goldin, Shaun G. Goodman

Medicine

Medicine

Résultat de recherche: Article › examen par les pairs

14 Citations (Scopus)

Résumé

Background: Canadian atrial fibrillation (AF) guidelines recommend that all AF patients be risk stratified with respect to stroke and bleeding, and that most should receive antithrombotic therapy. Methods: As part of the Canadian Facilitating Review and Education to Opti. mize Stroke Prevention in Atrial Fibrillation (FREEDOM AF) chart audit, data were collected on 4670 patients ≥ 18 years old without significant valvular heart disease from the primary care practices of 474 physicians (February to September, 2011). Results: Physicians did not provide an estimate of stroke and bleeding risk in 15% and 25% of patients, respectively. When risks were provided, they were on the basis of a predictive stroke and bleeding risk index in only 50% and 26% of patients, respectively. There were over- and underestimation of stroke and bleeding risk in a large proportion of patients. Antithrombotic therapy included warfarin (90%); 24% of patients had a time in the therapeutic range (TTR) < 50%, 9% between 50% and 60%, 11% between 60% and 70%, and 56% had a TTR ≥ 70%. Conclusions: In a large Canadian AF population, primary care physicians did not provide a stroke or bleeding risk in a substantial proportion of their AF patients. When estimates were provided, they were on the basis of a predictive stroke and bleeding risk index in less than half of the patients. Furthermore, there was under- and overestimation of stroke and bleeding risk in a substantial proportion of patients. As many as 1 in 3 patients receiving warfarin have their TTR < 60%. These findings suggest an opportunity to enhance knowledge translation to primary care physicians

Langue d'origine	English
Pages (de-à)	336-343
Nombre de pages	8
Journal	Canadian Journal of Cardiology
Volume	32
Numéro de publication	3
DOI	https://doi.org/10.1016/j.cjca.2015.07.012
Statut de publication	Published - mars 1 2016

Note bibliographique

Funding Information:
Dr Shaun Goodman is supported by the Heart and Stroke Foundation of Ontario in his role as Heart and Stroke Foundation (Polo) Chair at the University of Toronto. FREEDOM AF was conceived, designed, coordinated, and managed independently by the Canadian Heart Research Centre. FREEDOM AF was sponsored by an unrestricted research grant from Boehringer Ingelheim Canada. The authors/steering committee had exclusive involvement in the collection, analysis, and interpretation of data; and in the writing of, and in the decision to submit the report for publication.

Publisher Copyright:
© 2016 Canadian Cardiovascular Society.

ASJC Scopus Subject Areas

Cardiology and Cardiovascular Medicine

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10.1016/j.cjca.2015.07.012

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Angaran, P., Dorian, P., Tan, M. K., Kerr, C. R., Green, M. S., Gladstone, D. J., Mitchell, L. B., Fournier, C., Cox, J. L., Talajic, M., Lin, P. J., Langer, A., Goldin, L., & Goodman, S. G. (2016). The Risk Stratification and Stroke Prevention Therapy Care Gap in Canadian Atrial Fibrillation Patients. Canadian Journal of Cardiology, 32(3), 336-343. https://doi.org/10.1016/j.cjca.2015.07.012

Angaran, P, Dorian, P, Tan, MK, Kerr, CR, Green, MS, Gladstone, DJ, Mitchell, LB, Fournier, C, Cox, JL, Talajic, M, Lin, PJ, Langer, A, Goldin, L & Goodman, SG 2016, 'The Risk Stratification and Stroke Prevention Therapy Care Gap in Canadian Atrial Fibrillation Patients', Canadian Journal of Cardiology, vol. 32, n° 3, pp. 336-343. https://doi.org/10.1016/j.cjca.2015.07.012

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title = "The Risk Stratification and Stroke Prevention Therapy Care Gap in Canadian Atrial Fibrillation Patients",

abstract = "Background: Canadian atrial fibrillation (AF) guidelines recommend that all AF patients be risk stratified with respect to stroke and bleeding, and that most should receive antithrombotic therapy. Methods: As part of the Canadian Facilitating Review and Education to Opti. mize Stroke Prevention in Atrial Fibrillation (FREEDOM AF) chart audit, data were collected on 4670 patients ≥ 18 years old without significant valvular heart disease from the primary care practices of 474 physicians (February to September, 2011). Results: Physicians did not provide an estimate of stroke and bleeding risk in 15% and 25% of patients, respectively. When risks were provided, they were on the basis of a predictive stroke and bleeding risk index in only 50% and 26% of patients, respectively. There were over- and underestimation of stroke and bleeding risk in a large proportion of patients. Antithrombotic therapy included warfarin (90%); 24% of patients had a time in the therapeutic range (TTR) < 50%, 9% between 50% and 60%, 11% between 60% and 70%, and 56% had a TTR ≥ 70%. Conclusions: In a large Canadian AF population, primary care physicians did not provide a stroke or bleeding risk in a substantial proportion of their AF patients. When estimates were provided, they were on the basis of a predictive stroke and bleeding risk index in less than half of the patients. Furthermore, there was under- and overestimation of stroke and bleeding risk in a substantial proportion of patients. As many as 1 in 3 patients receiving warfarin have their TTR < 60%. These findings suggest an opportunity to enhance knowledge translation to primary care physicians",

author = "Paul Angaran and Paul Dorian and Tan, {Mary K.} and Kerr, {Charles R.} and Green, {Martin S.} and Gladstone, {David J.} and Mitchell, {L. Brent} and Carl Fournier and Cox, {Jafna L.} and Mario Talajic and Lin, {Peter J.} and Anatoly Langer and Lianne Goldin and Goodman, {Shaun G.}",

note = "Funding Information: Dr Shaun Goodman is supported by the Heart and Stroke Foundation of Ontario in his role as Heart and Stroke Foundation (Polo) Chair at the University of Toronto. FREEDOM AF was conceived, designed, coordinated, and managed independently by the Canadian Heart Research Centre. FREEDOM AF was sponsored by an unrestricted research grant from Boehringer Ingelheim Canada. The authors/steering committee had exclusive involvement in the collection, analysis, and interpretation of data; and in the writing of, and in the decision to submit the report for publication. Publisher Copyright: {\textcopyright} 2016 Canadian Cardiovascular Society.",

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doi = "10.1016/j.cjca.2015.07.012",

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AU - Angaran, Paul

AU - Dorian, Paul

AU - Tan, Mary K.

AU - Kerr, Charles R.

AU - Green, Martin S.

AU - Gladstone, David J.

AU - Mitchell, L. Brent

AU - Fournier, Carl

AU - Cox, Jafna L.

AU - Talajic, Mario

AU - Lin, Peter J.

AU - Langer, Anatoly

AU - Goldin, Lianne

AU - Goodman, Shaun G.

N1 - Funding Information: Dr Shaun Goodman is supported by the Heart and Stroke Foundation of Ontario in his role as Heart and Stroke Foundation (Polo) Chair at the University of Toronto. FREEDOM AF was conceived, designed, coordinated, and managed independently by the Canadian Heart Research Centre. FREEDOM AF was sponsored by an unrestricted research grant from Boehringer Ingelheim Canada. The authors/steering committee had exclusive involvement in the collection, analysis, and interpretation of data; and in the writing of, and in the decision to submit the report for publication. Publisher Copyright: © 2016 Canadian Cardiovascular Society.

PY - 2016/3/1

Y1 - 2016/3/1

N2 - Background: Canadian atrial fibrillation (AF) guidelines recommend that all AF patients be risk stratified with respect to stroke and bleeding, and that most should receive antithrombotic therapy. Methods: As part of the Canadian Facilitating Review and Education to Opti. mize Stroke Prevention in Atrial Fibrillation (FREEDOM AF) chart audit, data were collected on 4670 patients ≥ 18 years old without significant valvular heart disease from the primary care practices of 474 physicians (February to September, 2011). Results: Physicians did not provide an estimate of stroke and bleeding risk in 15% and 25% of patients, respectively. When risks were provided, they were on the basis of a predictive stroke and bleeding risk index in only 50% and 26% of patients, respectively. There were over- and underestimation of stroke and bleeding risk in a large proportion of patients. Antithrombotic therapy included warfarin (90%); 24% of patients had a time in the therapeutic range (TTR) < 50%, 9% between 50% and 60%, 11% between 60% and 70%, and 56% had a TTR ≥ 70%. Conclusions: In a large Canadian AF population, primary care physicians did not provide a stroke or bleeding risk in a substantial proportion of their AF patients. When estimates were provided, they were on the basis of a predictive stroke and bleeding risk index in less than half of the patients. Furthermore, there was under- and overestimation of stroke and bleeding risk in a substantial proportion of patients. As many as 1 in 3 patients receiving warfarin have their TTR < 60%. These findings suggest an opportunity to enhance knowledge translation to primary care physicians

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The Risk Stratification and Stroke Prevention Therapy Care Gap in Canadian Atrial Fibrillation Patients

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