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• W2893283323 abstract "The management of atrial fibrillation (AF) patients undergoing percutaneous coronary intervention (PCI) is rapidly evolving. Recently, an update to the Canadian Cardiovascular Society (CCS) AF guidelines was published. As compliance with guideline recommendations is associated with improved patient outcomes, we sought to determine the rate of compliance with these recommendations at our institution. We undertook a single-center retrospective cohort study of consecutive AF and flutter patients undergoing PCI with placement of a coronary stent in 2017. The primary outcome of interest was the recommended antithrombotic regimen at discharge. For the expected treatment, the CHADS2 score was calculated for each patient and combined with the patient’s age to determine the indication for anticoagulation. Patients with an estimated glomerular filtration rate (eGFR) ≥30mL/min with a guidelines indication for oral anticoagulation were assigned to non-vitamin K antagonist OAC (NOAC), whereas those with eGFR <30mL/min were assigned to a vitamin K antagonist (VKA). Patients without an indication for OAC were assigned dual antiplatelet therapy at discharge. These expected rates were then compared to the observed rates using the Chi2 test. (Four patients enrolled in a clinical trial or for whom the type of anticoagulation was otherwise not known, but who had eGFR ≥ 30mL/min were assumed to have received NOAC therapy for this analysis.) We also compared observed versus expected rates for an earlier (2014-2015) cohort from the same institution. Clinical characteristics were largely similar between the cohorts. Since the publication of the CCS guidelines in 2016, however, there has been a clear change in clinical practice (TABLE), with the rate of anticoagulation following PCI increasing from 34% to 77% and the rate of NOAC prescription at discharge increasing from 30% to 84%. While the rate of NOAC prescription among patients receiving, anticoagulation is similar to what would be expected according to guidelines (84% vs. 92%, p=0.09), the overall rate of anticoagulation remains below what would be expected (77% vs. 96%, p<0.001) with perfect compliance. This gap does not appear to be explained by bleeding risk, as the HASBLED scores of those not anticoagulated were similar to those of the overall cohort (1, IQR 1-2). There has been significant uptake of the CCS AF guidelines at our institution, especially with regards to the rate NOAC prescription. However, opportunities still exist for practice optimization with regards to the overall rate of anticoagulation of AF patients following PCI." @default.
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• W2893283323 date "2018-10-01" @default.
• W2893283323 modified "2023-09-26" @default.
• W2893283323 title "UPTAKE OF THE 2016 CCS AF GUIDELINES FOR PATIENTS WITH ATRIAL FIBRILLATION UNDERGOING PERCUTANEOUS CORONARY INTERVENTION" @default.
• W2893283323 doi "https://doi.org/10.1016/j.cjca.2018.07.169" @default.
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