Anticoagulation Quality Assessment and Risk Evaluation in Patients with Nonvalvular Atrial Fibrillation (NVAF)

Abstract

Specific Aims: To describe patients’ antithrombotic selection based on their CHA2DS2-VASc score to identify treatment gaps in preventing strokes among patients with nonvalvular atrial fibrillation. Methods: Retrospective descriptive study of patients diagnosed with nonvalvular atrial fibrillation at an outpatient cardiology clinic. De-identified data was extracted from Aprima electronic health record and was collected for patients seen between January 1, 2020 and April 15, 2022. Types of data collected included demographics, height and weight, labs, medications of interest, and conditions of interest. Only patients with a high CHA2DS2-VASc score category were included in the final data analysis, which was conducted using Minitab. Results: A total of 213 patients were included in the final analysis (mean age = 78; SD = 9; 79% Caucasian; 53% male). Overall, 65% of patients were on oral anticoagulants, and about 72% of patients had a CHA2DS2-VASc score ≥4. 36% of high-risk patients were not receiving oral anticoagulant therapy. For patients with CHA2DS2-VASc score of 2 through 5, more than 10% of patients were not on antithrombotic therapy and met the criteria for therapy. Among patients on alternative direct oral anticoagulant dosing, approximately 60% were dosed lower than label dosing. Conclusions: This study highlights treatment gaps among patients with nonvalvular atrial fibrillation and describes those not on guideline-based antithrombic therapy and the use of alternative dosing with direct oral anticoagulants.