Characterization of Patients with Atrial Fibrillation Treated Inadequately with Anticoagulants: Why Hospitalization Is Not an Opportunity to Correct Errors.

Abstract

Background: Atrial fibrillation (AF) is a common cardiac arrhythmia. Prevalence increases with age. It is a major public health concern due to high risk of thromboembolic complications such as stroke and systemic embolism. Direct oral anticoagulants (DOACs) have been shown to have improved safety and efficacy profiles and are the preferred therapy in all recent guidelines. However, patients are still discharged from internal medicine wards without appropriate DOAC therapy.

Objectives: To investigate the effectiveness of hospitalization in correcting inappropriate therapy for AF in patients who were hospitalized in the internal medicine departments for any reason and discharged without receiving DOAC therapy.

Methods: In this retrospective cohort study, we gathered data from electronic medical records at Sheba Medical Center on 222 patients. The patients were divided into three groups based on the anticoagulation therapy they received.

Results: The patient cohort (mean age of 77.1 years; 42.3% males; 21.6% presented with cognitive impairment. Researchers identified several potential contraindications for DOACs (renal disease in 24.3%, mechanical valves in 14.4%). When comparing patients with and without DOAC contraindications, there were no statistically significant differences regarding cognitive impairment rates or the lack of anticoagulation therapy. We further divided patients who did not receive DOACs into two groups: 134 due to contraindications and 88 mistakenly. Between these groups, baseline factors showed no statistically significant differences.

Conclusions: We found that older patients received less standardized care. Findings emphasize the need to consider individual patient characteristics and co-morbidities to eliminate management errors and improve the quality of clinical care.