Cardiovascular Disease |

Management of Stroke Risk in Patients Diagnosed With Atrial Fibrillation in a Tertiary Care Center FREE TO VIEW

Jamil Abuzetun*, MD; Tammy Burrns, PharmD; Luke Hvass, BS; Mohamed El Khashab, MBChB; Demi McCashland, PharmD; Hussam Abuissa, MD; Airey Kelly, MD
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The Cardiac Center of Creighton University, Omaha, NE

Chest. 2012;142(4_MeetingAbstracts):109A. doi:10.1378/chest.1382521
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SESSION TYPE: Arrhythmias Posters

PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: Atrial fibrillation (AF) is a common arrhythmia, responsible for a 5 fold increase in stroke risk. In the 80-89 year old age group, AF causes 24% of strokes. The use of antithrombotic agents has been proven to decrease these complications. The utilization of these agents in hospitalized patients who develop AF is not well studied.

METHODS: We conducted a retrospective chart review of all patients who were admitted to Creighton University Medical Center between December 1, 2010 and January 31, 2011 who had AF diagnosed by telemetry. Demographic data, CHADS2 score, AF type, symptom profile, treatment received, and the use of antiplatelet or anticoagulation therapy prescribed during hospitalization and at discharge were abstracted from the patient record.

RESULTS: One hundred forty-six patients were identified. Mean age was 72 years, 64% (94) were male. Comorbidities included HF 44% (64), HTN 82% (120), DM 25% (36), TIA/CVA 14% (20). AF was previously diagnosed in 52% (76), 18% (27) were post operative, 26% (38) had symptomatic AF. The mean CHADS2 score was 2.2. The duration of AF was greater than 300 minutes in 75% (110). During the hospital stay, 20% (29) did not receive anticoagulation and 8.2% (12) did not receive antiplatelet or anticoagulant therapy. At discharge, 42% (61) did not receive anticoagulation despite 74% (45) having a CHADS2 score of ≥ 2, and 15% (22) were discharged without anti-platelet or anti-coagulant therapy. Of the patients discharged without antiplatelet or anticoagulant therapy, only 13% had a formal assessment of stroke risk documented in the chart. Of the patients who didn`t receive anticoagulation at the time of discharge, bleeding events were documented in 18% (11).

CONCLUSIONS: Our study demonstrates that 31% of patients with documented AF during hospitalization did not receive anticoagulant or antiplatelet therapy at the time of discharge despite having CHADS2 score of ≥2. Full stoke assessment profiles were only performed on a small percentage of patients.

CLINICAL IMPLICATIONS: Strategies should be implemented to increase the awareness of the stroke risk associated with AF in hospitalized patients, which may improve the utilization of anticoagulation in such a high-risk group

DISCLOSURE: The following authors have nothing to disclose: Jamil Abuzetun, Tammy Burrns, Luke Hvass, Mohamed El Khashab, Demi McCashland, Hussam Abuissa, Airey Kelly

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The Cardiac Center of Creighton University, Omaha, NE




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