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Healthcare 2015, 3(1), 130-145; doi:10.3390/healthcare3010130

Variation in Anticoagulant Recommendations by the Guidelines and Decision Tools among Patients with Atrial Fibrillation

1
Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
2
Department of Pharmacy Practice, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
3
Department of Family Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
*
Author to whom correspondence should be addressed.
Academic Editor: Hector P. Rodriguez
Received: 6 December 2014 / Revised: 7 January 2015 / Accepted: 20 February 2015 / Published: 5 March 2015
(This article belongs to the Special Issue Innovations in Measuring and Improving Patient Care Experiences)
View Full-Text   |   Download PDF [609 KB, uploaded 5 March 2015]   |  

Abstract

Published atrial fibrillation (AF) guidelines and decision tools offer oral anticoagulant (OAC) recommendations; however, they consider stroke and bleeding risk differently. The aims of our study are: (i) to compare the variation in OAC recommendations by the 2012 American College of Chest Physicians guidelines, the 2012 European Society of Cardiology (ESC) guidelines, the 2014 American Heart Association (AHA) guidelines and two published decision tools by Casciano and LaHaye; (ii) to compare the concordance with actual OAC use in the overall study population and the population stratified by stroke/bleed risk. A cross-sectional study using the 2001–2013 Lifelink claims data was used to contrast the treatment recommendations by these decision aids. CHA2DS2-VASc and HAS-BLED algorithms were used to stratify 15,129 AF patients into nine stroke/bleed risk groups to study the variation in treatment recommendations and concordance with actual OAC use/non-use. The AHA guidelines which were set to recommend OAC when CHA2DS2-VASc = 1 recommended OAC most often (86.30%) and the LaHaye tool recommended OAC the least often (14.91%). OAC treatment recommendations varied considerably when stroke risk was moderate or high (CHA2DS2-VASc > 0). Actual OAC use/non-use was highly discordant (>40%) with all of the guidelines or decision tools reflecting substantial opportunities to improve AF OAC decisions. View Full-Text
Keywords: atrial fibrillation; guidelines; decision tools; overuse; underuse; oral anticoagulants; warfarin; recommendations atrial fibrillation; guidelines; decision tools; overuse; underuse; oral anticoagulants; warfarin; recommendations
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).

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MDPI and ACS Style

Shewale, A.; Johnson, J.; Li, C.; Nelsen, D.; Martin, B. Variation in Anticoagulant Recommendations by the Guidelines and Decision Tools among Patients with Atrial Fibrillation. Healthcare 2015, 3, 130-145.

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