TY - JOUR
T1 - Screening over 100 000 patients in 39 general practices in the Netherlands for anticoagulation underprescription in atrial fibrillation
T2 - a descriptive, cross-sectional study
AU - Voorhout, Leonard
AU - Pisters, Ron
AU - Geurts, Constants H. P. H.
AU - Oostindjer, Andrew
AU - van Doorn, Sander
AU - Rila, Harrie
AU - Fuijkschot, Wessel W.
AU - Verheugt, Freek
AU - Hemels, Martin E. W.
N1 - Funding Information: The author(s) disclosed receipt of the following financial support for the research of this article: Kinase was supported by BMS/Pfizer. Publisher Copyright: © 2023 BMJ Publishing Group. All rights reserved.
PY - 2023/8/18
Y1 - 2023/8/18
N2 - OBJECTIVES: To investigate the underprescription of oral anticoagulation (OAC) in individual atrial fibrillation (AF) patients in primary care. SETTING: Screening of patient records in 39 participating general practitioners (GPs) across the Netherlands. PARTICIPANTS: We screened 101 207 patient records identifying 2375 non-valvular AF patients. METHODS: Using electronic patient files, we were able to screen the entire GP population for AF, CHA2DS2-VASc stroke risk scores, and the use of guidelines recommended OAC prescription. In case of a deviation from guidelines recommended OAC prescription, we checked the electronic patient file for any documented reason. Additionally, 6 weeks following the screening, we asked all GPs to provide information on any actions taken for the underprescribed patients. RESULTS: We found a mean CHA2DS2-VASc score of 3.2. OAC prescription consisted of direct OAC in 1342/1984 (68%) and vitamin K-antagonists in the remainder of patients. OAC underprescription was present in 93/944 (9.9%) females and 101/1374 (9.7%) in males, respectively. In 111/146 (76.0%) of the underprescribed AF patients, no reason to withhold OAC was reported. Reported reasons to withhold OAC were patient refusal (n=10), cardiologist advice (n=7) and high risk of bleeding (n=7). Data regarding actions following the identification of OAC underprescription were available for 92/194 (47%) of the OAC underprescribed cases. After consultation OAC was initiated in 9/92 (10%) only. CONCLUSIONS: In this large Dutch study among GPs, we observed 9.8% underprescription of OAC in AF patients. In 76% of the AF patients lacking a prescription for OAC, no documentation for deviating from the guidelines was found. Only in a minority of cases detection of OAC underprescription lead to OAC initiation.
AB - OBJECTIVES: To investigate the underprescription of oral anticoagulation (OAC) in individual atrial fibrillation (AF) patients in primary care. SETTING: Screening of patient records in 39 participating general practitioners (GPs) across the Netherlands. PARTICIPANTS: We screened 101 207 patient records identifying 2375 non-valvular AF patients. METHODS: Using electronic patient files, we were able to screen the entire GP population for AF, CHA2DS2-VASc stroke risk scores, and the use of guidelines recommended OAC prescription. In case of a deviation from guidelines recommended OAC prescription, we checked the electronic patient file for any documented reason. Additionally, 6 weeks following the screening, we asked all GPs to provide information on any actions taken for the underprescribed patients. RESULTS: We found a mean CHA2DS2-VASc score of 3.2. OAC prescription consisted of direct OAC in 1342/1984 (68%) and vitamin K-antagonists in the remainder of patients. OAC underprescription was present in 93/944 (9.9%) females and 101/1374 (9.7%) in males, respectively. In 111/146 (76.0%) of the underprescribed AF patients, no reason to withhold OAC was reported. Reported reasons to withhold OAC were patient refusal (n=10), cardiologist advice (n=7) and high risk of bleeding (n=7). Data regarding actions following the identification of OAC underprescription were available for 92/194 (47%) of the OAC underprescribed cases. After consultation OAC was initiated in 9/92 (10%) only. CONCLUSIONS: In this large Dutch study among GPs, we observed 9.8% underprescription of OAC in AF patients. In 76% of the AF patients lacking a prescription for OAC, no documentation for deviating from the guidelines was found. Only in a minority of cases detection of OAC underprescription lead to OAC initiation.
KW - pacing & electrophysiology
KW - primary care
KW - protocols & guidelines
KW - thromboembolism
UR - http://www.scopus.com/inward/record.url?scp=85168321513&partnerID=8YFLogxK
U2 - https://doi.org/10.1136/bmjopen-2023-072655
DO - https://doi.org/10.1136/bmjopen-2023-072655
M3 - Article
C2 - 37597862
SN - 2044-6055
VL - 13
SP - e072655
JO - BMJ Open
JF - BMJ Open
IS - 8
M1 - e072655
ER -