Evaluation of Guideline-Directed Medical Therapy for the Reduction of Stroke and Systemic Embolism in Hospitalized Patients with Nonvalvular Atrial Fibrillation

Abstract

Background: Guidelines recommend antithrombotic therapy in patients with nonvalvular atrial fibrillation (NVAF) to reduce the risk of stroke and systemic embolism (SSE) based on an assessment utilizing the CHA₂DS₂-VASc score. However, a treatment gap exists regarding patients at risk for thromboembolic events. Objectives: The aim of this study was to characterize the use of guideline-directed medical therapy (GDMT) to reduce the risk of SSE in patients with NVAF upon hospital discharge. Methods: This retrospective review evaluated patients admitted to a community hospital with NVAF in 2016. All patients were included except for the following: < 18 years of age, concomitant valvular heart disease, expired during hospitalization, or discharged on hospice care. Descriptive statistics were reported for all parameters. Results: A total of 2739 patients with NVAF were included with 59.9% discharged on GDMT to reduce the risk of SSE. A 1% increase in GDMT at discharge was observed in patients admitted with a history of NVAF (n = 2238; 60.1% vs 61.1%). Patients with first-detected NVAF (n = 501) were discharged on GDMT 54.5% of the time. In patients with a high stroke risk, concomitant heart failure (P = .001) and a lower HAS-BLED score (mean = 2.85 vs 3.18; P < .0001) were associated with receiving GDMT upon discharge. However, patients with increased age (mean = 78.5 vs 76.4; P < .0001), vascular disease (P = .02), prior major bleeding (P < .0001), or first-detected NVAF (P < .0001) were less likely to be discharged on GDMT. Conclusions: Consistent with published registry data, a gap was observed in the use of GDMT to reduce the risk of SSE in patients with NVAF at this institution. Further investigation into methods for improvement is warranted.