TY - JOUR
T1 - Oral anticoagulant therapy in adults with congenital heart disease and atrial arrhythmias: Implementation of guidelines
T2 - Implementation of guidelines
AU - Yang, H.
AU - Heidendael, J. F.
AU - de Groot, J. R.
AU - Konings, T. C.
AU - Veen, G.
AU - van Dijk, A. P. J.
AU - Meijboom, F. J.
AU - Sieswerda, G. Tj.
AU - Post, M. C.
AU - Winter, M. M.
AU - Mulder, B. J. M.
AU - Bouma, B. J.
PY - 2018/4/15
Y1 - 2018/4/15
N2 - Background: Current guidelines on oral anticoagulation (OAC) in adults with congenital heart disease (ACHD) and atrial arrhythmias (AA) consist of heterogeneous and divergent recommendations with limited level of evidence, possibly leading to diverse OAC management and different outcomes. Therefore, we aimed to evaluate real-world implementation and outcome of three guidelines on OAC management in ACHD patients with AA. Methods: The ESC GUCH 2010, PACES/HRS 2014 and ESC atrial fibrillation (AF) 2016 guidelines were assessed for implementation. ACHD patients with recurrent or sustained non-valvular AA from 5 tertiary centers were identified using a national ACHD registry. After two years of prospective follow-up, thromboembolism, major bleeding and death were assessed. Results: In total, 225 adults (mean age 54 ± 15 years, 55% male) with various defects (simple 43%; moderate 37%; complex 20%) and AA were included. Following the most strict indication (OAC is recommended in all three guidelines), one should treat a mere 37% of ACHD patients with AA, whereas following the least strict indication (OAC is recommended in any one of the three guidelines), one should treat 98% of patients. The various guidelines were implemented in 54–80% of patients. From all recommendations, Fontan circulation, CHA2DS2-VASc ≥ 1 and AF were independently associated with OAC prescription. Superiority of any guideline in identifying outcome (n = 15) could not be demonstrated. Conclusions: The implementation of current guidelines on OAC management in ACHD patients with AA is low, probably due to substantial heterogeneity among guidelines. OAC prescription in daily practice was most consistent in patients with AF and CHA2DS2-VASc ≥ 1 or Fontan circulation.
AB - Background: Current guidelines on oral anticoagulation (OAC) in adults with congenital heart disease (ACHD) and atrial arrhythmias (AA) consist of heterogeneous and divergent recommendations with limited level of evidence, possibly leading to diverse OAC management and different outcomes. Therefore, we aimed to evaluate real-world implementation and outcome of three guidelines on OAC management in ACHD patients with AA. Methods: The ESC GUCH 2010, PACES/HRS 2014 and ESC atrial fibrillation (AF) 2016 guidelines were assessed for implementation. ACHD patients with recurrent or sustained non-valvular AA from 5 tertiary centers were identified using a national ACHD registry. After two years of prospective follow-up, thromboembolism, major bleeding and death were assessed. Results: In total, 225 adults (mean age 54 ± 15 years, 55% male) with various defects (simple 43%; moderate 37%; complex 20%) and AA were included. Following the most strict indication (OAC is recommended in all three guidelines), one should treat a mere 37% of ACHD patients with AA, whereas following the least strict indication (OAC is recommended in any one of the three guidelines), one should treat 98% of patients. The various guidelines were implemented in 54–80% of patients. From all recommendations, Fontan circulation, CHA2DS2-VASc ≥ 1 and AF were independently associated with OAC prescription. Superiority of any guideline in identifying outcome (n = 15) could not be demonstrated. Conclusions: The implementation of current guidelines on OAC management in ACHD patients with AA is low, probably due to substantial heterogeneity among guidelines. OAC prescription in daily practice was most consistent in patients with AF and CHA2DS2-VASc ≥ 1 or Fontan circulation.
KW - Adult congenital heart disease
KW - Anticoagulation
KW - Atrial arrhythmias
KW - Guidelines
KW - Implementation
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85042654509&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/29506740
UR - http://www.scopus.com/inward/record.url?scp=85042654509&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.ijcard.2017.12.038
DO - https://doi.org/10.1016/j.ijcard.2017.12.038
M3 - Article
C2 - 29506740
SN - 0167-5273
VL - 257
SP - 67
EP - 74
JO - International Journal of Cardiology
JF - International Journal of Cardiology
ER -